- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $263.03 / $562.34
| Facility | | $114.82 | $263.03 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $47.86 / $47.86
| Facility | 26 | $8.91 | $47.86 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $295.12 / $676.08
| Facility | TC | $173.78 | $295.12 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $32.36 / $112.20
| Professional | | $10.47 | $32.36 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $13.80 / $38.02
| Professional | 26 | $7.08 | $13.80 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $144.54
| Professional | 50 | $141.25 | $141.25 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $32.36 / $100.00
| Professional | TC | $18.20 | $32.36 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $112.20 / $724.44
| Facility | | $29.51 | $112.20 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $36.31 / $61.66
| Professional | | $26.92 | $36.31 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $10.72 / $16.98
| Professional | 26 | $8.13 | $10.72 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $24.55 / $43.65
| Professional | TC | $18.20 | $24.55 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $33.11 / $60.26
| Professional | | $14.45 | $33.11 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $181.97 / $281.84
| Facility | | $125.89 | $181.97 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | 26 | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | TC | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $48.98 / $60.26
| Professional | | $40.74 | $48.98 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $12.59 / $18.62
| Professional | 26 | $10.72 | $12.59 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $40.74
| Professional | TC | $30.20 | $35.48 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $61.66
| Professional | | $27.54 | $44.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.30 / $18.20
| Professional | 26 | $7.59 | $12.30 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $38.90
| Professional | TC | $19.95 | $33.11 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $30.20 / $54.95
| Professional | | $10.96 | $30.20 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $29.51 / $50.12
| Professional | | $25.70 | $29.51 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $8.71 / $14.45
| Professional | 26 | $6.92 | $8.71 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $20.42 / $35.48
| Professional | TC | $17.78 | $20.42 | $35.48 |