- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $199.53 / $630.96
| Facility | | $58.88 | $199.53 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $14.45 / $14.45
| Facility | 26 | $10.23 | $14.45 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $380.19
| Facility | TC | $44.67 | $44.67 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $40.74 / $107.15
| Professional | | $10.72 | $40.74 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $15.14 / $43.65
| Professional | 26 | $8.91 | $15.14 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $40.74 / $52.48 / $186.21
| Professional | 50 | $40.74 | $52.48 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $43.65 / $93.33
| Professional | TC | $25.70 | $43.65 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $60.26
| Professional | | $32.36 | $38.90 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $9.55 / $13.80
| Professional | 26 | $8.13 | $9.55 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $30.90 / $44.67
| Professional | TC | $20.89 | $30.90 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $93.33 / $125.89
| Facility | | $79.43 | $93.33 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $43.65 / $56.23
| Professional | | $30.90 | $43.65 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $10.72 / $13.49
| Professional | 26 | $7.41 | $10.72 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $42.66
| Professional | TC | $22.91 | $33.11 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $114.82 / $213.80
| Facility | | $60.26 | $114.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $47.86 / $100.00
| Professional | | $33.11 | $47.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $14.13 / $27.54
| Professional | 26 | $9.12 | $14.13 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $37.15 / $85.11
| Professional | TC | $26.30 | $37.15 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $128.82 / $158.49
| Facility | | $28.84 | $128.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $43.65 / $83.18
| Professional | | $32.36 | $43.65 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $11.48 / $66.07
| Professional | 26 | $8.71 | $11.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $64.57
| Professional | TC | $22.91 | $32.36 | $64.57 |