- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $302.00 / $478.63
| Facility | | $93.33 | $302.00 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $15.85
| Facility | 26 | $8.91 | $8.91 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $47.86 / $323.59
| Facility | TC | $22.91 | $47.86 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $37.15 / $112.20
| Professional | | $8.91 | $37.15 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $13.18 / $38.90
| Professional | 26 | $8.32 | $13.18 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $30.20 / $100.00 / $141.25
| Professional | 50 | $30.20 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $50.12 / $229.09
| Professional | TC | $20.89 | $50.12 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $89.13
| Professional | | $60.26 | $79.43 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $20.89 / $23.44
| Professional | 26 | $15.85 | $20.89 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $120.23 / $158.49 / $177.83
| Professional | 50 | $120.23 | $158.49 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $58.88 / $66.07
| Professional | TC | $44.67 | $58.88 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $52.48 / $81.28
| Professional | | $32.36 | $52.48 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $14.13 / $22.91
| Professional | 26 | $9.12 | $14.13 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $39.81 / $58.88
| Professional | TC | $22.91 | $39.81 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $74.13 / $213.80
| Facility | | $33.11 | $74.13 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $199.53 / $263.03
| Facility | TC | $141.25 | $199.53 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $54.95 / $223.87
| Professional | | $28.18 | $54.95 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $18.20 / $89.13
| Professional | 26 | $11.75 | $18.20 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $39.81 / $177.83
| Professional | TC | $22.39 | $39.81 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $61.66 / $100.00
| Professional | | $32.36 | $61.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $16.60 / $30.20
| Professional | 26 | $9.33 | $16.60 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $45.71 / $100.00
| Professional | TC | $22.39 | $45.71 | $100.00 |