- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $190.55 / $467.74
| Facility | | $38.90 | $190.55 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.47 / $27.54
| Facility | 26 | $6.92 | $10.47 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $66.07 / $338.84
| Facility | TC | $22.91 | $66.07 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $35.48 / $107.15
| Professional | | $13.49 | $35.48 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.88 / $36.31
| Professional | 26 | $7.08 | $12.88 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $74.13 / $245.47
| Professional | 50 | $33.11 | $74.13 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $12.88 / $26.30 / $63.10
| Professional | 52 | $12.88 | $26.30 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $61.66
| Professional | TC | $18.20 | $26.30 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $85.11 / $269.15
| Facility | | $26.30 | $85.11 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $8.91
| Facility | 26 | $8.91 | $8.91 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Facility | TC | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $34.67 / $66.07
| Professional | | $24.55 | $34.67 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $10.47 / $18.20
| Professional | 26 | $6.61 | $10.47 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $37.15 / $51.29 / $95.50
| Professional | 50 | $37.15 | $51.29 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $48.98
| Professional | TC | $17.38 | $24.55 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $93.33 / $269.15
| Facility | | $47.86 | $93.33 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.86 / $10.00 / $26.30
| Facility | 26 | $1.86 | $10.00 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.62 / $30.20 / $91.20
| Facility | TC | $5.62 | $30.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $39.81 / $81.28
| Professional | | $24.55 | $39.81 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $10.96 / $20.89
| Professional | 26 | $6.46 | $10.96 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $30.20 / $43.65 / $46.77
| Professional | 50 | $30.20 | $43.65 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $28.84 / $63.10
| Professional | TC | $17.78 | $28.84 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $81.28 / $218.78
| Facility | | $18.62 | $81.28 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.02 / $95.50
| Professional | | $25.12 | $38.02 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.47 / $52.48
| Professional | 26 | $6.92 | $10.47 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | 52 | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $28.18 / $95.50
| Professional | TC | $17.78 | $28.18 | $95.50 |