- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $128.82 / $323.59
| Facility | | $38.90 | $128.82 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $12.02 / $14.45
| Facility | 26 | $10.96 | $12.02 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $30.20 / $190.55
| Facility | TC | $26.92 | $30.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $34.67 / $89.13
| Professional | | $12.02 | $34.67 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.02 / $38.90
| Professional | 26 | $7.08 | $12.02 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $28.18 / $141.25 / $199.53
| Professional | 50 | $28.18 | $141.25 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $26.30 / $58.88
| Professional | TC | $19.05 | $26.30 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $29.51
| Professional | | $25.12 | $25.12 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $8.71 / $14.13
| Professional | 26 | $7.24 | $8.71 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $24.55 / $25.12
| Professional | TC | $22.39 | $24.55 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $104.71
| Facility | | $75.86 | $75.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $35.48 / $45.71
| Professional | | $30.90 | $35.48 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $10.47 / $13.49
| Professional | 26 | $9.12 | $10.47 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $25.12 / $31.62
| Professional | TC | $21.88 | $25.12 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $32.36 / $56.23
| Facility | | $10.96 | $32.36 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $30.20 / $54.95
| Professional | | $9.55 | $30.20 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $107.15 / $229.09
| Facility | | $33.88 | $107.15 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.14 / $10.00 / $14.13
| Facility | 26 | $2.14 | $10.00 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.31 / $29.51 / $41.69
| Facility | TC | $6.31 | $29.51 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $39.81 / $64.57
| Professional | | $28.84 | $39.81 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $11.75 / $17.78
| Professional | 26 | $7.76 | $11.75 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $46.77
| Professional | TC | $19.95 | $27.54 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $67.61
| Professional | | $38.90 | $57.54 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $16.98 / $21.38
| Professional | 26 | $11.48 | $16.98 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $38.90 / $53.70
| Professional | TC | $29.51 | $38.90 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $251.19
| Facility | | $89.13 | $141.25 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $70.79
| Professional | | $30.20 | $36.31 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $10.72 / $18.62
| Professional | 26 | $8.32 | $10.72 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $25.70 / $47.86
| Professional | TC | $20.89 | $25.70 | $47.86 |