- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $288.40 / $501.19
| Facility | | $39.81 | $288.40 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.13 / $14.45
| Facility | 26 | $7.08 | $8.13 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $28.18 / $288.40
| Facility | TC | $18.62 | $28.18 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $31.62 / $102.33
| Professional | | $14.13 | $31.62 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.88 / $34.67
| Professional | 26 | $7.08 | $12.88 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $50.12 / $91.20 / $144.54
| Professional | 50 | $50.12 | $91.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $22.39 / $46.77
| Professional | TC | $15.85 | $22.39 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $26.30 / $34.67
| Professional | | $18.62 | $26.30 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $9.12 / $10.47
| Professional | 26 | $6.31 | $9.12 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Professional | 50 | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $19.95 / $25.70
| Professional | TC | $17.78 | $19.95 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $28.18 / $47.86
| Professional | | $25.12 | $28.18 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $8.32 / $14.45
| Professional | 26 | $7.94 | $8.32 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $37.15 / $41.69 / $72.44
| Professional | 50 | $37.15 | $41.69 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $17.78 / $33.11
| Professional | TC | $17.38 | $17.78 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $24.55 / $37.15
| Facility | | $8.13 | $24.55 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $19.95 / $34.67
| Professional | | $8.13 | $19.95 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $75.86
| Facility | | $45.71 | $45.71 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.95 / $9.12 / $13.18
| Facility | 26 | $1.95 | $9.12 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.01 / $23.44 / $33.11
| Facility | TC | $5.01 | $23.44 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $138.04
| Professional | | $25.12 | $41.69 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $12.30 / $37.15
| Professional | 26 | $6.92 | $12.30 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $32.36 / $100.00
| Professional | TC | $17.78 | $32.36 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $32.36 / $33.11
| Professional | | $14.13 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $23.99 / $66.07
| Facility | | $6.61 | $23.99 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $28.84 / $47.86
| Professional | | $23.44 | $28.84 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $8.32 / $15.14
| Professional | 26 | $6.92 | $8.32 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $19.95 / $34.67
| Professional | TC | $16.22 | $19.95 | $34.67 |