- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $338.84 / $676.08
| Facility | | $95.50 | $338.84 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $14.13
| Facility | 26 | $7.94 | $7.94 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $26.92 / $354.81
| Facility | TC | $25.12 | $26.92 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $33.11 / $85.11
| Professional | | $7.94 | $33.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $14.13 / $37.15
| Professional | 26 | $7.08 | $14.13 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $134.90
| Professional | 50 | $67.61 | $107.15 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $52.48
| Professional | 52 | $28.18 | $45.71 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $41.69 / $75.86
| Professional | TC | $19.50 | $41.69 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $77.62 / $87.10
| Professional | | $58.88 | $77.62 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $18.62 / $20.42
| Professional | 26 | $14.13 | $18.62 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $154.88 / $173.78
| Professional | 50 | $117.49 | $154.88 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $60.26 / $67.61
| Professional | TC | $45.71 | $60.26 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $81.28
| Professional | | $32.36 | $51.29 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $12.88 / $20.42
| Professional | 26 | $8.32 | $12.88 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $39.81 / $63.10
| Professional | TC | $22.39 | $39.81 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $57.54 / $173.78
| Facility | | $33.88 | $57.54 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $91.20 / $288.40
| Facility | TC | $83.18 | $91.20 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $57.54 / $218.78
| Professional | | $30.90 | $57.54 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $16.98 / $67.61
| Professional | 26 | $9.33 | $16.98 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $42.66 / $169.82
| Professional | TC | $23.99 | $42.66 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $60.26 / $100.00
| Professional | | $32.36 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $14.79 / $29.51
| Professional | 26 | $8.71 | $14.79 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $44.67 / $100.00
| Professional | TC | $23.99 | $44.67 | $100.00 |