- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $91.20 / $288.40
| Facility | | $36.31 | $91.20 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $9.12 / $19.05
| Facility | 26 | $7.41 | $9.12 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $32.36 / $467.74
| Facility | TC | $23.99 | $32.36 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $35.48 / $114.82
| Professional | | $12.02 | $35.48 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $11.48 / $35.48
| Professional | 26 | $6.76 | $11.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $158.49 / $309.03 / $323.59
| Professional | 50 | $158.49 | $309.03 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $10.96 / $18.20 / $40.74
| Professional | 52 | $10.96 | $18.20 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $25.70 / $51.29
| Professional | TC | $18.62 | $25.70 | $51.29 |
- 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
- $23.44 / $32.36 / $58.88
| Professional | | $23.44 | $32.36 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $9.12 / $16.60
| Professional | 26 | $5.62 | $9.12 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $23.99 / $44.67
| Professional | TC | $16.60 | $23.99 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $151.36 / $177.83
| Facility | | $45.71 | $151.36 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $281.84
| Facility | TC | $213.80 | $213.80 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Professional | | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $14.13 / $125.89
| Professional | 26 | $7.24 | $14.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $162.18
| Professional | | $25.70 | $38.90 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $11.22 / $79.43
| Professional | 26 | $6.17 | $11.22 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $27.54 / $123.03
| Professional | TC | $18.62 | $27.54 | $123.03 |