- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $239.88 / $478.63
| Facility | | $63.10 | $239.88 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.13 / $14.13
| Facility | 26 | $7.08 | $8.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $85.11 / $416.87
| Facility | TC | $23.44 | $85.11 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $33.11 / $74.13
| Professional | | $8.91 | $33.11 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.30 / $43.65
| Professional | 26 | $7.59 | $12.30 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $120.23 / $151.36 / $154.88
| Professional | 50 | $120.23 | $151.36 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $33.11 / $75.86
| Professional | TC | $23.44 | $33.11 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $35.48 / $52.48
| Professional | | $26.30 | $35.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.91 / $12.02
| Professional | 26 | $7.08 | $8.91 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $41.69 / $46.77 / $67.61
| Professional | 50 | $41.69 | $46.77 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $35.48 / $47.86
| Professional | TC | $29.51 | $35.48 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $102.33
| Facility | | $51.29 | $72.44 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $37.15 / $51.29
| Professional | | $9.12 | $37.15 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $131.83 / $131.83
| Facility | | $33.11 | $131.83 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $8.51 / $13.49
| Facility | 26 | $8.51 | $8.51 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $28.84
| Facility | TC | $19.05 | $19.05 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $34.67 / $56.23
| Professional | | $27.54 | $34.67 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $9.12 / $15.14
| Professional | 26 | $7.76 | $9.12 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $41.69
| Professional | TC | $19.05 | $25.70 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $51.29 / $346.74
| Facility | | $30.90 | $51.29 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $100.00 / $100.00
| Facility | 26 | $20.89 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $144.54 / $144.54
| Facility | TC | $67.61 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $39.81 / $263.03
| Professional | | $31.62 | $39.81 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $10.00 / $79.43
| Professional | 26 | $8.32 | $10.00 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $28.18 / $204.17
| Professional | TC | $22.39 | $28.18 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $70.79 / $208.93
| Facility | | $22.91 | $70.79 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $38.02 / $74.13
| Professional | | $30.90 | $38.02 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $9.33 / $16.98
| Professional | 26 | $8.32 | $9.33 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $27.54 / $48.98
| Professional | TC | $22.39 | $27.54 | $48.98 |