- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $147.91 / $467.74
| Facility | | $69.18 | $147.91 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $19.50 / $50.12
| Facility | 26 | $6.03 | $19.50 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $61.66 / $151.36
| Facility | TC | $20.89 | $61.66 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $25.70 / $72.44
| Professional | | $10.23 | $25.70 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $15.85 / $35.48
| Professional | 26 | $7.08 | $15.85 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $134.90 / $281.84
| Professional | 50 | $33.11 | $134.90 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $30.20 / $64.57
| Professional | TC | $16.98 | $30.20 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $33.11 / $104.71
| Professional | | $22.39 | $33.11 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $7.41 / $8.13
| Professional | 26 | $7.24 | $7.41 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $25.12 / $30.20
| Professional | TC | $22.39 | $25.12 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $165.96 / $177.83
| Facility | | $100.00 | $165.96 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $33.88 / $70.79
| Professional | | $23.44 | $33.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $9.33 / $18.62
| Professional | 26 | $6.46 | $9.33 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $23.44 / $52.48
| Professional | TC | $17.38 | $23.44 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $69.18
| Professional | | $28.18 | $33.88 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.32 / $16.98
| Professional | 26 | $7.08 | $8.32 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $25.12 / $52.48
| Professional | TC | $21.38 | $25.12 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $416.87 / $489.78
| Facility | | $128.82 | $416.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $87.10 / $177.83
| Professional | | $25.70 | $87.10 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $50.12 / $95.50
| Professional | 26 | $7.76 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $66.07 / $125.89
| Professional | TC | $18.62 | $66.07 | $125.89 |