- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $239.88 / $389.05
| Facility | | $131.83 | $239.88 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | 26 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $239.88 / $467.74
| Facility | TC | $87.10 | $239.88 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $45.71 / $120.23
| Professional | | $11.48 | $45.71 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $18.20 / $46.77
| Professional | 26 | $7.59 | $18.20 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $44.67 / $190.55 / $354.81
| Professional | 50 | $44.67 | $190.55 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $30.90 / $79.43
| Professional | TC | $20.89 | $30.90 | $79.43 |
- 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
- $36.31 / $51.29 / $81.28
| Professional | | $36.31 | $51.29 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.23 / $17.38
| Professional | 26 | $7.24 | $10.23 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $38.90 / $54.95
| Professional | TC | $28.84 | $38.90 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $173.78 / $302.00
| Facility | | $154.88 | $173.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $60.26 / $97.72
| Professional | | $34.67 | $60.26 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.59 / $18.20
| Professional | 26 | $7.94 | $12.59 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $48.98 / $79.43
| Professional | TC | $24.55 | $48.98 | $79.43 |
- 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
- $25.12 / $43.65 / $56.23
| Professional | | $25.12 | $43.65 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.23 / $13.18
| Professional | 26 | $7.94 | $10.23 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $34.67 / $44.67
| Professional | TC | $19.50 | $34.67 | $44.67 |