- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $186.21 / $426.58
| Facility | | $95.50 | $186.21 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.00 / $162.18
| Facility | 26 | $7.24 | $10.00 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $181.97 / $616.60
| Facility | TC | $35.48 | $181.97 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $39.81 / $128.82
| Professional | | $8.91 | $39.81 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $17.38 / $40.74
| Professional | 26 | $7.94 | $17.38 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.78 / $70.79 / $147.91
| Professional | 50 | $17.78 | $70.79 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $42.66 / $97.72
| Professional | TC | $22.91 | $42.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $42.66
| Professional | | $30.20 | $38.02 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $8.32 / $9.77
| Professional | 26 | $7.94 | $8.32 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $30.20 / $36.31
| Professional | TC | $26.30 | $30.20 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $57.54
| Facility | | $35.48 | $35.48 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $13.49 / $13.49
| Facility | 26 | $13.49 | $13.49 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Facility | TC | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $36.31 / $67.61
| Professional | | $26.92 | $36.31 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $9.55 / $17.78
| Professional | 26 | $6.31 | $9.55 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $56.23
| Professional | TC | $19.95 | $26.92 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $44.67 / $61.66
| Professional | | $38.02 | $44.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $10.00 / $13.49
| Professional | 26 | $8.91 | $10.00 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $35.48 / $47.86
| Professional | TC | $29.51 | $35.48 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $17.78 / $33.88
| Facility | | $6.31 | $17.78 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $77.62
| Professional | | $25.12 | $37.15 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $9.55 / $19.50
| Professional | 26 | $6.61 | $9.55 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $27.54 / $58.88
| Professional | TC | $19.05 | $27.54 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $43.65 / $60.26
| Professional | | $24.55 | $43.65 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.37 / $9.55 / $13.18
| Professional | 26 | $5.37 | $9.55 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $34.67 / $47.86
| Professional | TC | $19.05 | $34.67 | $47.86 |