- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $190.55 / $407.38
| Facility | | $39.81 | $190.55 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $10.00 / $21.88
| Facility | 26 | $8.32 | $10.00 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $47.86 / $537.03
| Facility | TC | $25.70 | $47.86 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $34.67 / $91.20
| Professional | | $8.91 | $34.67 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $12.30 / $37.15
| Professional | 26 | $7.76 | $12.30 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $169.82 / $338.84
| Professional | 50 | $89.13 | $169.82 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $26.92 / $61.66
| Professional | TC | $19.50 | $26.92 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $64.57
| Professional | | $25.12 | $38.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $11.22 / $17.38
| Professional | 26 | $6.31 | $11.22 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $27.54 / $47.86
| Professional | TC | $18.62 | $27.54 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $213.80 / $457.09
| Facility | | $177.83 | $213.80 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $354.81
| Facility | TC | $234.42 | $234.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Professional | | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $22.39 / $380.19
| Professional | 26 | $7.94 | $22.39 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Professional | TC | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $177.83
| Professional | | $28.18 | $40.74 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.88 / $79.43
| Professional | 26 | $7.08 | $12.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $26.30 / $57.54
| Professional | TC | $19.95 | $26.30 | $57.54 |