- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $218.78 / $436.52
| Facility | | $69.18 | $218.78 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.23 / $26.92
| Facility | 26 | $7.94 | $10.23 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $309.03
| Facility | TC | $22.91 | $38.02 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $34.67 / $109.65
| Professional | | $9.33 | $34.67 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $14.45 / $42.66
| Professional | 26 | $7.08 | $14.45 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.90 / $95.50 / $194.98
| Professional | 50 | $38.90 | $95.50 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $33.11 / $72.44
| Professional | TC | $20.89 | $33.11 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $58.88 / $69.18
| Professional | | $31.62 | $58.88 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $14.79 / $21.88
| Professional | 26 | $8.32 | $14.79 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $29.51 / $41.69
| Professional | TC | $21.38 | $29.51 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Professional | | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $21.88 / $26.92
| Professional | 26 | $14.45 | $21.88 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $42.66 / $67.61
| Professional | TC | $33.88 | $42.66 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $97.72 / $162.18
| Facility | | $41.69 | $97.72 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $48.98 / $89.13
| Professional | | $28.18 | $48.98 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $13.80 / $23.99
| Professional | 26 | $7.59 | $13.80 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $35.48 / $64.57
| Professional | TC | $21.38 | $35.48 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $39.81 / $70.79
| Facility | | $28.84 | $39.81 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $1,318.26
| Facility | | $257.04 | $257.04 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $33.11 / $66.07
| Professional | | $9.12 | $33.11 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $42.66 / $89.13
| Facility | | $12.59 | $42.66 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $41.69 / $83.18
| Professional | | $30.20 | $41.69 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $12.30 / $26.30
| Professional | 26 | $8.71 | $12.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $28.84 / $53.70
| Professional | TC | $21.38 | $28.84 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $363.08
| Facility | | $223.87 | $223.87 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $85.11
| Facility | 26 | $70.79 | $70.79 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Facility | TC | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $302.00
| Professional | | $223.87 | $223.87 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | 26 | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $229.09
| Professional | TC | $169.82 | $169.82 | $229.09 |