- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $93.33 / $588.84
| Facility | | $63.10 | $93.33 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $19.50 / $50.12
| Facility | 26 | $6.03 | $19.50 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $67.61 / $169.82
| Facility | TC | $22.91 | $67.61 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $28.84 / $87.10
| Professional | | $8.71 | $28.84 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $16.22 / $43.65
| Professional | 26 | $7.08 | $16.22 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $117.49 / $199.53
| Professional | 50 | $33.11 | $117.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $33.11 / $70.79
| Professional | TC | $19.05 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $36.31 / $120.23
| Professional | | $32.36 | $36.31 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $8.13 / $9.77
| Professional | 26 | $7.24 | $8.13 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $25.12 / $27.54
| Professional | TC | $24.55 | $25.12 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $165.96 / $199.53
| Facility | | $112.20 | $165.96 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $33.88 / $77.62
| Professional | | $25.70 | $33.88 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $9.77 / $20.42
| Professional | 26 | $6.46 | $9.77 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $23.99 / $58.88
| Professional | TC | $18.62 | $23.99 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $36.31 / $75.86
| Professional | | $30.90 | $36.31 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.32 / $16.98
| Professional | 26 | $7.08 | $8.32 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $28.18 / $57.54
| Professional | TC | $23.99 | $28.18 | $57.54 |
- 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
- $26.92 / $95.50 / $173.78
| Professional | | $26.92 | $95.50 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $52.48 / $95.50
| Professional | 26 | $7.41 | $52.48 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $74.13 / $123.03
| Professional | TC | $19.05 | $74.13 | $123.03 |