- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $83.18 / $275.42
| Facility | | $34.67 | $83.18 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $9.12 / $19.95
| Facility | 26 | $7.76 | $9.12 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $40.74 / $575.44
| Facility | TC | $22.91 | $40.74 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $33.88 / $95.50
| Professional | | $12.30 | $33.88 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.88 / $34.67
| Professional | 26 | $7.08 | $12.88 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $56.23 / $89.13 / $269.15
| Professional | 50 | $56.23 | $89.13 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $10.96 / $19.05 / $40.74
| Professional | 52 | $10.96 | $19.05 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $23.99 / $61.66
| Professional | TC | $17.78 | $23.99 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Facility | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $53.70
| Professional | | $21.88 | $32.36 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $9.12 / $16.60
| Professional | 26 | $5.75 | $9.12 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $23.44 / $38.90
| Professional | TC | $15.85 | $23.44 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $147.91 / $275.42
| Facility | | $44.67 | $147.91 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $549.54
| Facility | TC | $363.08 | $363.08 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $14.79 / $46.77
| Professional | 26 | $7.24 | $14.79 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $38.90 / $158.49
| Professional | | $24.55 | $38.90 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $11.75 / $79.43
| Professional | 26 | $6.31 | $11.75 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $27.54 / $117.49
| Professional | TC | $18.20 | $27.54 | $117.49 |