- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $288.40 / $407.38
| Facility | | $177.83 | $288.40 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Facility | 26 | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $239.88 / $309.03
| Facility | TC | $89.13 | $239.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $38.02 / $109.65
| Professional | | $9.12 | $38.02 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $17.78 / $44.67
| Professional | 26 | $7.08 | $17.78 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $37.15 / $112.20 / $331.13
| Professional | 50 | $37.15 | $112.20 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $26.92 / $75.86
| Professional | TC | $17.38 | $26.92 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $141.25 / $204.17
| Facility | | $93.33 | $141.25 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $45.71 / $70.79
| Professional | | $31.62 | $45.71 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.23 / $17.38
| Professional | 26 | $7.24 | $10.23 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $34.67 / $47.86
| Professional | TC | $24.55 | $34.67 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $173.78 / $302.00
| Facility | | $138.04 | $173.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $85.11
| Professional | | $30.90 | $52.48 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.59 / $18.20
| Professional | 26 | $7.94 | $12.59 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $43.65 / $67.61
| Professional | TC | $24.55 | $43.65 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $50.12
| Professional | | $25.12 | $38.90 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $13.18
| Professional | 26 | $7.94 | $10.00 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $30.20 / $38.90
| Professional | TC | $17.38 | $30.20 | $38.90 |