- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $323.59 / $524.81
| Facility | | $112.20 | $323.59 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $16.60
| Facility | 26 | $8.91 | $8.91 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $33.11 / $288.40
| Facility | TC | $28.84 | $33.11 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $41.69 / $123.03
| Professional | | $8.91 | $41.69 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $17.78 / $46.77
| Professional | 26 | $8.13 | $17.78 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $27.54 / $81.28 / $154.88
| Professional | 50 | $27.54 | $81.28 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $61.66 / $208.93
| Professional | TC | $25.12 | $61.66 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $93.33 / $104.71
| Professional | | $70.79 | $93.33 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $20.89 / $23.44
| Professional | 26 | $15.85 | $20.89 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $186.21 / $208.93
| Professional | 50 | $141.25 | $186.21 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $72.44 / $81.28
| Professional | TC | $54.95 | $72.44 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $61.66 / $97.72
| Professional | | $35.48 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $14.13 / $22.91
| Professional | 26 | $9.12 | $14.13 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $48.98 / $74.13
| Professional | TC | $25.12 | $48.98 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $70.79 / $186.21
| Facility | | $38.90 | $70.79 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $112.20 / $147.91
| Facility | TC | $89.13 | $112.20 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $69.18 / $263.03
| Professional | | $37.15 | $69.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $19.05 / $50.12
| Professional | 26 | $11.75 | $19.05 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $50.12 / $204.17
| Professional | TC | $28.18 | $50.12 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $74.13 / $117.49
| Professional | | $38.02 | $74.13 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $16.98 / $30.20
| Professional | 26 | $9.33 | $16.98 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $56.23 / $100.00
| Professional | TC | $27.54 | $56.23 | $100.00 |