- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $169.82 / $501.19
| Facility | | $93.33 | $169.82 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $23.44 / $69.18
| Facility | 26 | $8.91 | $23.44 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $95.50 / $263.03
| Facility | TC | $34.67 | $95.50 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $40.74 / $114.82
| Professional | | $10.96 | $40.74 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $15.14 / $33.11
| Professional | 26 | $8.91 | $15.14 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $186.21
| Professional | 50 | $52.48 | $52.48 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $51.29 / $91.20
| Professional | TC | $28.84 | $51.29 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $48.98 / $131.83
| Professional | | $38.90 | $48.98 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $11.48 / $11.48
| Professional | 26 | $10.23 | $11.48 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $38.02 / $38.90
| Professional | TC | $29.51 | $38.02 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $288.40 / $302.00
| Facility | | $173.78 | $288.40 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $114.82
| Professional | | $37.15 | $48.98 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $12.88 / $27.54
| Professional | 26 | $9.12 | $12.88 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $91.20
| Professional | TC | $28.18 | $37.15 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $56.23 / $112.20
| Professional | | $47.86 | $56.23 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $11.75 / $23.99
| Professional | 26 | $10.00 | $11.75 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $44.67 / $89.13
| Professional | TC | $38.02 | $44.67 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $416.87 / $489.78
| Facility | | $128.82 | $416.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $95.50 / $245.47
| Professional | | $41.69 | $95.50 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $66.07 / $69.18
| Professional | 26 | $10.23 | $66.07 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $95.50 / $234.42
| Professional | TC | $27.54 | $95.50 | $234.42 |