- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $257.04 / $489.78
| Facility | | $66.07 | $257.04 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $10.47 / $14.45
| Facility | 26 | $7.76 | $10.47 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $38.02 / $407.38
| Facility | TC | $25.12 | $38.02 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $37.15 / $100.00
| Professional | | $8.71 | $37.15 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $15.14 / $43.65
| Professional | 26 | $7.76 | $15.14 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $40.74 / $97.72 / $213.80
| Professional | 50 | $40.74 | $97.72 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $60.26 / $97.72 / $97.72
| Professional | 52 | $60.26 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $40.74 / $79.43
| Professional | TC | $22.91 | $40.74 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $53.70
| Professional | | $25.12 | $34.67 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $7.76 / $15.49
| Professional | 26 | $6.17 | $7.76 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $32.36 / $61.66 / $107.15
| Professional | 50 | $32.36 | $61.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $29.51 / $47.86
| Professional | TC | $20.42 | $29.51 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $199.53 / $354.81
| Facility | | $30.90 | $199.53 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $42.66 / $72.44
| Professional | | $28.18 | $42.66 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $11.48 / $17.78
| Professional | 26 | $8.71 | $11.48 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $109.65
| Professional | 50 | $42.66 | $64.57 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $58.88
| Professional | TC | $19.05 | $28.84 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $30.90 / $45.71
| Facility | | $8.71 | $30.90 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $30.90 / $44.67
| Professional | | $8.71 | $30.90 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $61.66 / $199.53
| Facility | | $33.11 | $61.66 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $41.69 / $77.62
| Professional | | $27.54 | $41.69 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $11.22 / $18.20
| Professional | 26 | $7.24 | $11.22 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $29.51 / $58.88
| Professional | TC | $20.42 | $29.51 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $74.13 / $74.13
| Facility | | $11.22 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $35.48 / $74.13
| Professional | | $28.18 | $35.48 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $9.55 / $37.15
| Professional | 26 | $7.59 | $9.55 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $26.30 / $53.70
| Professional | TC | $19.50 | $26.30 | $53.70 |