- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $229.09 / $691.83
| Facility | | $91.20 | $229.09 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $22.91 / $58.88
| Facility | 26 | $7.94 | $22.91 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $89.13 / $223.87
| Facility | TC | $30.90 | $89.13 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $38.90 / $128.82
| Professional | | $9.33 | $38.90 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $19.05 / $42.66
| Professional | 26 | $8.32 | $19.05 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $35.48 / $107.15 / $234.42
| Professional | 50 | $35.48 | $107.15 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $48.98 / $93.33
| Professional | TC | $25.70 | $48.98 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $41.69 / $123.03
| Professional | | $9.55 | $41.69 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $8.71 / $8.71
| Professional | 26 | $8.51 | $8.71 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $33.11 / $69.18
| Professional | TC | $31.62 | $33.11 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $218.78 / $263.03
| Facility | | $147.91 | $218.78 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $100.00
| Professional | | $32.36 | $45.71 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $10.96 / $22.91
| Professional | 26 | $7.76 | $10.96 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $77.62
| Professional | TC | $23.44 | $32.36 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $48.98 / $97.72
| Professional | | $41.69 | $48.98 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $10.23 / $19.95
| Professional | 26 | $8.71 | $10.23 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $77.62
| Professional | TC | $33.11 | $38.90 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $416.87 / $489.78
| Facility | | $128.82 | $416.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $95.50 / $239.88
| Professional | | $35.48 | $95.50 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $60.26 / $60.26
| Professional | 26 | $8.71 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $95.50 / $177.83
| Professional | TC | $26.92 | $95.50 | $177.83 |