- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $123.03 / $436.52
| Facility | | $69.18 | $123.03 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $32.36 / $38.02
| Facility | 26 | $10.23 | $32.36 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $85.11 / $251.19
| Facility | TC | $54.95 | $85.11 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $33.88 / $134.90
| Professional | | $8.51 | $33.88 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $15.85 / $45.71
| Professional | 26 | $7.08 | $15.85 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $26.30 / $107.15 / $295.12
| Professional | 50 | $26.30 | $107.15 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $28.18 / $52.48 / $251.19
| Professional | 52 | $28.18 | $52.48 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $34.67 / $79.43
| Professional | TC | $19.05 | $34.67 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $89.13
| Facility | | $40.74 | $58.88 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $43.65 / $72.44
| Professional | | $28.84 | $43.65 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $11.48 / $19.50
| Professional | 26 | $6.76 | $11.48 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $97.72
| Professional | 50 | $42.66 | $64.57 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $56.23
| Professional | TC | $21.88 | $32.36 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $89.13 / $199.53
| Facility | | $51.29 | $89.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $48.98 / $85.11
| Professional | | $32.36 | $48.98 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $12.30 / $19.05
| Professional | 26 | $9.12 | $12.30 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $36.31 / $75.86
| Professional | TC | $22.39 | $36.31 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $53.70
| Professional | | $30.20 | $36.31 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $10.96 / $13.18
| Professional | 26 | $8.71 | $10.96 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $36.31 / $45.71
| Professional | TC | $21.38 | $36.31 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $218.78 / $331.13
| Facility | | $147.91 | $218.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $16.60 / $64.57
| Professional | | $12.88 | $16.60 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $100.00
| Professional | | $28.18 | $44.67 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.47 / $28.18
| Professional | 26 | $7.08 | $10.47 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $34.67 / $79.43
| Professional | TC | $19.95 | $34.67 | $79.43 |