- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $177.83 / $478.63
| Facility | | $35.48 | $177.83 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $9.77 / $23.44
| Facility | 26 | $6.31 | $9.77 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $63.10 / $389.05
| Facility | TC | $20.42 | $63.10 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $37.15 / $109.65
| Professional | | $16.60 | $37.15 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $14.13 / $40.74
| Professional | 26 | $6.03 | $14.13 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $22.39 / $83.18 / $257.04
| Professional | 50 | $22.39 | $83.18 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $15.85 / $28.84 / $158.49
| Professional | 52 | $15.85 | $28.84 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $58.88
| Professional | TC | $15.85 | $23.99 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $72.44 / $269.15
| Facility | | $25.70 | $72.44 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $8.13
| Facility | 26 | $8.13 | $8.13 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.05
| Facility | TC | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $60.26
| Professional | | $23.44 | $32.36 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $10.00 / $17.78
| Professional | 26 | $6.46 | $10.00 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $36.31 / $46.77 / $87.10
| Professional | 50 | $36.31 | $46.77 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $22.91 / $43.65
| Professional | TC | $16.60 | $22.91 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $83.18 / $263.03
| Facility | | $42.66 | $83.18 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.82 / $9.55 / $25.12
| Facility | 26 | $1.82 | $9.55 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.90 / $26.30 / $79.43
| Facility | TC | $4.90 | $26.30 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $36.31 / $72.44
| Professional | | $22.39 | $36.31 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $10.47 / $19.95
| Professional | 26 | $6.17 | $10.47 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $28.84 / $39.81 / $42.66
| Professional | 50 | $28.84 | $39.81 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $26.30 / $54.95
| Professional | TC | $16.22 | $26.30 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $81.28 / $218.78
| Facility | | $18.20 | $81.28 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $95.50
| Professional | | $22.91 | $33.88 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $9.55 / $52.48
| Professional | 26 | $6.61 | $9.55 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | 50 | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $24.55 / $95.50
| Professional | TC | $16.60 | $24.55 | $95.50 |