- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $302.00 / $489.78
| Facility | | $128.82 | $302.00 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $14.79
| Facility | 26 | $7.94 | $7.94 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $25.12 / $302.00
| Facility | TC | $21.88 | $25.12 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $36.31 / $87.10
| Professional | | $10.23 | $36.31 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $12.88 / $36.31
| Professional | 26 | $7.41 | $12.88 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Professional | 50 | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $45.71 / $95.50
| Professional | TC | $19.95 | $45.71 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $75.86 / $83.18
| Professional | | $57.54 | $75.86 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $19.50 / $21.38
| Professional | 26 | $14.45 | $19.50 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $169.82
| Professional | 50 | $114.82 | $151.36 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $56.23 / $63.10
| Professional | TC | $42.66 | $56.23 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $81.28
| Professional | | $32.36 | $50.12 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $12.30 / $20.89
| Professional | 26 | $8.32 | $12.30 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $37.15 / $58.88
| Professional | TC | $23.99 | $37.15 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $56.23 / $199.53
| Facility | | $30.90 | $56.23 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $223.87 / $295.12
| Facility | TC | $173.78 | $223.87 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $57.54 / $208.93
| Professional | | $29.51 | $57.54 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $16.98 / $74.13
| Professional | 26 | $9.77 | $16.98 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $42.66 / $177.83
| Professional | TC | $22.39 | $42.66 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $58.88 / $100.00
| Professional | | $31.62 | $58.88 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $15.49 / $28.18
| Professional | 26 | $8.71 | $15.49 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $43.65 / $100.00
| Professional | TC | $22.39 | $43.65 | $100.00 |