- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $131.83 / $338.84
| Facility | | $33.88 | $131.83 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.47 / $13.49
| Facility | 26 | $10.00 | $10.47 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $26.92 / $186.21
| Facility | TC | $22.91 | $26.92 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $33.11 / $100.00
| Professional | | $13.18 | $33.11 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $12.88 / $36.31
| Professional | 26 | $6.31 | $12.88 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $87.10 / $257.04
| Professional | 50 | $33.11 | $87.10 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $25.70 / $47.86
| Professional | TC | $16.98 | $25.70 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $25.70 / $47.86
| Professional | | $23.99 | $25.70 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $7.59 / $12.59
| Professional | 26 | $6.17 | $7.59 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | 50 | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $21.88 / $22.91
| Professional | TC | $19.50 | $21.88 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $104.71
| Facility | | $75.86 | $75.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $35.48 / $45.71
| Professional | | $30.90 | $35.48 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $10.47 / $13.49
| Professional | 26 | $9.12 | $10.47 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $25.12 / $31.62
| Professional | TC | $21.88 | $25.12 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $28.84 / $50.12
| Facility | | $9.77 | $28.84 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $26.92 / $48.98
| Professional | | $8.51 | $26.92 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $162.18
| Facility | | $30.90 | $52.48 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.86 / $8.71 / $12.59
| Facility | 26 | $1.86 | $8.71 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.62 / $26.30 / $37.15
| Facility | TC | $5.62 | $26.30 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $57.54
| Professional | | $25.12 | $36.31 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.47 / $15.85
| Professional | 26 | $7.24 | $10.47 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $23.99 / $39.81
| Professional | TC | $17.78 | $23.99 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $48.98 / $58.88
| Professional | | $38.02 | $48.98 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $13.80 / $16.60
| Professional | 26 | $6.61 | $13.80 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $30.20 / $45.71
| Professional | TC | $20.42 | $30.20 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $251.19
| Facility | | $89.13 | $141.25 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $61.66
| Professional | | $26.30 | $32.36 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $9.33 / $16.60
| Professional | 26 | $7.41 | $9.33 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $23.44 / $45.71
| Professional | TC | $18.20 | $23.44 | $45.71 |