- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $91.20 / $426.58
| Facility | | $38.90 | $91.20 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $11.75 / $14.79
| Facility | 26 | $9.77 | $11.75 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $33.11 / $93.33
| Facility | TC | $28.84 | $33.11 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $33.11 / $141.25
| Professional | | $17.38 | $33.11 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $8.91 / $33.88
| Professional | 26 | $6.03 | $8.91 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $15.85
| Professional | 50 | $15.85 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $57.54
| Professional | 52 | $28.84 | $28.84 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $22.39 / $37.15
| Professional | TC | $15.85 | $22.39 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $21.88 / $22.39
| Professional | | $18.62 | $21.88 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $501.19 / $831.76
| Facility | | $141.25 | $501.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $21.88 / $46.77
| Professional | | $5.50 | $21.88 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Facility | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.02 / $54.95
| Professional | | $25.12 | $38.02 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $10.47 / $15.14
| Professional | 26 | $6.61 | $10.47 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $40.74
| Professional | TC | $18.20 | $26.92 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $32.36 / $37.15
| Professional | | $14.45 | $32.36 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $41.69 / $69.18
| Facility | | $28.18 | $41.69 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $46.77 / $72.44
| Professional | | $27.54 | $46.77 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $10.47 / $15.14
| Professional | 26 | $6.61 | $10.47 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $38.02
| Professional | TC | $19.95 | $26.92 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $169.82 / $380.19
| Facility | | $9.77 | $169.82 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $69.18
| Professional | | $26.30 | $32.36 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $8.71 / $23.44
| Professional | 26 | $7.59 | $8.71 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $23.44 / $50.12
| Professional | TC | $18.20 | $23.44 | $50.12 |