- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $346.74 / $812.83
| Facility | | $93.33 | $346.74 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $56.23 / $66.07
| Facility | 26 | $32.36 | $56.23 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $354.81 / $691.83
| Facility | TC | $95.50 | $354.81 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $38.90 / $131.83
| Professional | | $9.77 | $38.90 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.02 / $39.81
| Professional | 26 | $7.59 | $12.02 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $51.29 / $100.00 / $190.55
| Professional | 50 | $51.29 | $100.00 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $41.69 / $165.96
| Professional | TC | $19.05 | $41.69 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $52.48 / $102.33
| Professional | | $34.67 | $52.48 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $15.49 / $31.62
| Professional | 26 | $9.77 | $15.49 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $70.79
| Professional | TC | $25.12 | $36.31 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $93.33 / $812.83
| Facility | | $31.62 | $93.33 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $56.23 / $75.86
| Facility | 26 | $28.84 | $56.23 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $398.11 / $891.25
| Facility | TC | $72.44 | $398.11 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $89.13 / $173.78
| Professional | | $28.18 | $89.13 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $26.30 / $64.57
| Professional | 26 | $9.12 | $26.30 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $51.29 / $123.03 / $338.84
| Professional | 50 | $51.29 | $123.03 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $66.07 / $151.36
| Professional | TC | $25.70 | $66.07 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $141.25 / $199.53
| Professional | | $134.90 | $141.25 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $36.31 / $60.26
| Professional | 26 | $33.88 | $36.31 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $104.71 / $147.91
| Professional | TC | $70.79 | $104.71 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $47.86 / $89.13
| Facility | | $28.18 | $47.86 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $85.11 / $102.33
| Professional | | $36.31 | $85.11 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $12.88 / $33.11
| Professional | 26 | $7.76 | $12.88 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $70.79
| Professional | TC | $19.50 | $27.54 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $79.43 / $199.53
| Professional | | $38.90 | $79.43 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $26.30 / $66.07
| Professional | 26 | $10.23 | $26.30 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $52.48 / $131.83
| Professional | TC | $30.20 | $52.48 | $131.83 |