- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $173.78 / $398.11
| Facility | | $35.48 | $173.78 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $8.71 / $19.05
| Facility | 26 | $7.41 | $8.71 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $40.74 / $398.11
| Facility | TC | $23.44 | $40.74 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $33.88 / $91.20
| Professional | | $10.23 | $33.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $14.79 / $43.65
| Professional | 26 | $7.08 | $14.79 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $43.65 / $95.50 / $275.42
| Professional | 50 | $43.65 | $95.50 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $28.84 / $60.26
| Professional | TC | $17.38 | $28.84 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $57.54
| Professional | | $22.91 | $33.11 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $9.77 / $15.85
| Professional | 26 | $5.62 | $9.77 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $23.99 / $42.66
| Professional | TC | $16.22 | $23.99 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $177.83 / $229.09
| Facility | | $48.98 | $177.83 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Facility | TC | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.72 / $87.10
| Professional | 26 | $7.08 | $10.72 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Professional | TC | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $40.74 / $158.49
| Professional | | $24.55 | $40.74 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $11.22 / $79.43
| Professional | 26 | $6.46 | $11.22 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $28.18 / $120.23
| Professional | TC | $18.62 | $28.18 | $120.23 |