- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $251.19 / $512.86
| Facility | | $53.70 | $251.19 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $7.94 / $12.59
| Facility | 26 | $6.03 | $7.94 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $91.20 / $478.63
| Facility | TC | $20.89 | $91.20 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $29.51 / $66.07
| Professional | | $8.32 | $29.51 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $13.18 / $46.77
| Professional | 26 | $7.08 | $13.18 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $54.95 / $128.82 / $141.25
| Professional | 50 | $54.95 | $128.82 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $74.13
| Professional | TC | $20.89 | $32.36 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $29.51 / $44.67
| Professional | | $23.44 | $29.51 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $7.76 / $11.22
| Professional | 26 | $6.17 | $7.76 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $35.48 / $43.65 / $72.44
| Professional | 50 | $35.48 | $43.65 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $29.51 / $35.48
| Professional | TC | $26.30 | $29.51 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $102.33
| Facility | | $51.29 | $72.44 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $33.11 / $45.71
| Professional | | $8.32 | $33.11 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $120.23 / $120.23
| Facility | | $30.90 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $12.88
| Facility | 26 | $7.76 | $7.76 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $26.30
| Facility | TC | $17.38 | $17.38 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $31.62 / $51.29
| Professional | | $24.55 | $31.62 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $8.51 / $13.80
| Professional | 26 | $6.92 | $8.51 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $23.44 / $36.31
| Professional | TC | $17.38 | $23.44 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $275.42
| Facility | | $27.54 | $44.67 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $100.00 / $100.00
| Facility | 26 | $19.50 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $131.83 / $151.36
| Facility | TC | $61.66 | $131.83 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $36.31 / $234.42
| Professional | | $28.18 | $36.31 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $9.33 / $67.61
| Professional | 26 | $7.59 | $9.33 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $25.12 / $181.97
| Professional | TC | $19.95 | $25.12 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $70.79 / $208.93
| Facility | | $20.42 | $70.79 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $33.88 / $67.61
| Professional | | $26.92 | $33.88 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $8.51 / $15.85
| Professional | 26 | $7.59 | $8.51 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 50 | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $24.55 / $42.66
| Professional | TC | $19.95 | $24.55 | $42.66 |