- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $213.80 / $512.86
| Facility | | $45.71 | $213.80 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $17.38
| Facility | 26 | $7.94 | $10.00 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $114.82 / $363.08
| Facility | TC | $32.36 | $114.82 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $35.48 / $70.79
| Professional | | $9.55 | $35.48 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.23 / $28.84
| Professional | 26 | $7.08 | $10.23 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $26.30 / $102.33 / $107.15
| Professional | 50 | $26.30 | $102.33 | $107.15 |
- 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
- $22.91 / $30.20 / $58.88
| Professional | TC | $22.91 | $30.20 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $26.92 / $50.12
| Professional | | $22.39 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $6.46 / $9.55
| Professional | 26 | $6.17 | $6.46 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Professional | 50 | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $22.91 / $36.31
| Professional | TC | $18.62 | $22.91 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $131.83 / $190.55
| Facility | | $104.71 | $131.83 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Professional | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $107.15 / $194.98
| Facility | | $83.18 | $107.15 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $69.18
| Professional | | $25.12 | $38.90 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $16.98
| Professional | 26 | $7.08 | $10.96 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $32.36 / $54.95
| Professional | TC | $18.62 | $32.36 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $48.98 / $218.78
| Facility | | $34.67 | $48.98 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $100.00
| Facility | 26 | $19.50 | $19.50 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $125.89 / $398.11
| Facility | TC | $58.88 | $125.89 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $234.42
| Professional | | $30.20 | $40.74 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $11.22 / $70.79
| Professional | 26 | $8.32 | $11.22 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $30.20 / $181.97
| Professional | TC | $21.88 | $30.20 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $66.07 / $173.78
| Facility | | $25.12 | $66.07 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $66.07
| Professional | | $30.20 | $35.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $9.33 / $16.22
| Professional | 26 | $8.32 | $9.33 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $26.30 / $46.77
| Professional | TC | $21.88 | $26.30 | $46.77 |