- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $213.80 / $537.03
| Facility | | $38.90 | $213.80 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $12.02 / $30.90
| Facility | 26 | $8.32 | $12.02 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $56.23 / $389.05
| Facility | TC | $19.50 | $56.23 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $28.84 / $93.33
| Professional | | $8.91 | $28.84 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.96 / $30.20
| Professional | 26 | $6.03 | $10.96 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $29.51 / $77.62 / $1,174.90
| Professional | 50 | $29.51 | $77.62 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $25.12 / $70.79
| Professional | TC | $15.49 | $25.12 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $26.30 / $75.86
| Professional | | $25.12 | $26.30 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $9.77 / $24.55
| Professional | 26 | $9.55 | $9.77 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $177.83 / $199.53
| Facility | | $141.25 | $177.83 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $50.12 / $66.07
| Professional | | $31.62 | $50.12 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $12.02 / $17.38
| Professional | 26 | $7.76 | $12.02 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $46.77 / $74.13 / $97.72
| Professional | 50 | $46.77 | $74.13 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $37.15 / $50.12
| Professional | TC | $23.44 | $37.15 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $204.17 / $524.81
| Facility | | $112.20 | $204.17 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Facility | TC | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $47.86 / $87.10
| Professional | | $31.62 | $47.86 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $13.49 / $22.39
| Professional | 26 | $8.51 | $13.49 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $34.67 / $72.44
| Professional | TC | $23.99 | $34.67 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $56.23 / $89.13
| Professional | | $35.48 | $56.23 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $13.80 / $20.42
| Professional | 26 | $8.91 | $13.80 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $43.65 / $63.10
| Professional | TC | $27.54 | $43.65 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $112.20
| Professional | | $32.36 | $45.71 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $12.30 / $23.44
| Professional | 26 | $8.51 | $12.30 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $34.67 / $79.43
| Professional | TC | $24.55 | $34.67 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $31.62
| Facility | | $29.51 | $29.51 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $7.59
| Facility | 26 | $5.75 | $5.75 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $21.38 / $23.99
| Facility | TC | $19.05 | $21.38 | $23.99 |