- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $151.36 / $562.34
| Facility | | $31.62 | $151.36 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.72 / $10.72
| Facility | 26 | $7.94 | $10.72 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $31.62 / $501.19
| Facility | TC | $22.91 | $31.62 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $34.67 / $81.28
| Professional | | $16.98 | $34.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $16.60 / $39.81
| Professional | 26 | $7.08 | $16.60 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $134.90 / $208.93
| Professional | 50 | $33.11 | $134.90 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $10.23 / $32.36 / $100.00
| Professional | 52 | $10.23 | $32.36 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $29.51 / $64.57
| Professional | TC | $19.05 | $29.51 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $37.15
| Professional | | $20.89 | $26.92 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $8.91 / $11.22
| Professional | 26 | $5.89 | $8.91 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Professional | TC | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $93.33 / $125.89
| Facility | | $79.43 | $93.33 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $41.69 / $53.70
| Professional | | $29.51 | $41.69 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $12.30 / $15.85
| Professional | 26 | $8.71 | $12.30 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $29.51 / $38.02
| Professional | TC | $20.89 | $29.51 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $60.26 / $213.80
| Facility | | $40.74 | $60.26 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $9.12
| Facility | 26 | $8.91 | $8.91 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $19.05
| Facility | TC | $18.62 | $18.62 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $70.79
| Professional | | $22.91 | $34.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.96 / $20.89
| Professional | 26 | $6.92 | $10.96 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $26.92 / $63.10
| Professional | TC | $17.38 | $26.92 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $128.82 / $158.49
| Facility | | $19.50 | $128.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $31.62 / $58.88
| Professional | | $21.38 | $31.62 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $8.51 / $52.48
| Professional | 26 | $6.61 | $8.51 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $23.44 / $42.66
| Professional | TC | $15.49 | $23.44 | $42.66 |