- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $181.97 / $380.19
| Facility | | $120.23 | $181.97 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Facility | 26 | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $131.83 / $288.40
| Facility | TC | $128.82 | $131.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $37.15 / $102.33
| Professional | | $18.20 | $37.15 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $17.78 / $48.98
| Professional | 26 | $6.03 | $17.78 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $190.55 / $331.13
| Professional | 50 | $52.48 | $190.55 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $11.22 / $26.92 / $138.04
| Professional | 52 | $11.22 | $26.92 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $25.12 / $85.11
| Professional | TC | $15.85 | $25.12 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $138.04 / $194.98
| Facility | | $93.33 | $138.04 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $42.66 / $69.18
| Professional | | $29.51 | $42.66 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.00 / $19.05
| Professional | 26 | $6.92 | $10.00 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $31.62 / $43.65
| Professional | TC | $22.39 | $31.62 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $173.78 / $302.00
| Facility | | $125.89 | $173.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $48.98 / $79.43
| Professional | | $30.20 | $48.98 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.02 / $18.62
| Professional | 26 | $7.59 | $12.02 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $38.90 / $61.66
| Professional | TC | $22.91 | $38.90 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $35.48 / $47.86
| Professional | | $23.44 | $35.48 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $9.77 / $12.88
| Professional | 26 | $7.24 | $9.77 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $28.18 / $36.31
| Professional | TC | $16.22 | $28.18 | $36.31 |