- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $316.23 / $616.60
| Facility | | $56.23 | $316.23 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.71 / $12.88
| Facility | 26 | $7.08 | $8.71 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $295.12 / $616.60
| Facility | TC | $50.12 | $295.12 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $30.20 / $66.07
| Professional | | $16.98 | $30.20 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $16.60 / $34.67
| Professional | 26 | $7.08 | $16.60 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $97.72 / $208.93
| Professional | 50 | $52.48 | $97.72 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $26.92 / $27.54 / $100.00
| Professional | 52 | $26.92 | $27.54 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $72.44
| Professional | TC | $20.89 | $30.20 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $30.20 / $50.12
| Facility | | $9.77 | $30.20 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $34.67 / $69.18
| Professional | | $10.47 | $34.67 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $83.18 / $181.97
| Facility | | $52.48 | $83.18 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.95 / $9.12 / $13.18
| Facility | 26 | $1.95 | $9.12 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.03 / $28.18 / $39.81
| Facility | TC | $6.03 | $28.18 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $41.69 / $158.49
| Professional | | $26.30 | $41.69 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $11.48 / $41.69
| Professional | 26 | $6.46 | $11.48 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $32.36 / $120.23
| Professional | TC | $19.50 | $32.36 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $288.40 / $363.08
| Facility | | $97.72 | $288.40 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $269.15 / $380.19
| Facility | TC | $123.03 | $269.15 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $20.89 / $21.38
| Professional | 26 | $12.59 | $20.89 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $33.11 / $63.10
| Professional | | $21.38 | $33.11 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $9.12 / $18.62
| Professional | 26 | $5.89 | $9.12 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $44.67
| Professional | TC | $15.85 | $23.99 | $44.67 |