- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $79.43 / $177.83
| Facility | | $25.70 | $79.43 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.00 / $10.00
| Facility | 26 | $7.24 | $10.00 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $28.18
| Facility | TC | $18.20 | $25.70 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $30.90 / $89.13
| Professional | | $15.49 | $30.90 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $15.14 / $39.81
| Professional | 26 | $6.03 | $15.14 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $18.62 / $109.65 / $257.04
| Professional | 50 | $18.62 | $109.65 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $14.45 / $26.92 / $67.61
| Professional | 52 | $14.45 | $26.92 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $25.12 / $58.88
| Professional | TC | $15.49 | $25.12 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $19.50 / $26.30
| Professional | | $17.38 | $19.50 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $8.71 / $10.23
| Professional | 26 | $5.89 | $8.71 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $36.31
| Professional | 50 | $32.36 | $32.36 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $15.49 / $20.42
| Professional | TC | $14.79 | $15.49 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $93.33 / $125.89
| Facility | | $79.43 | $93.33 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.02 / $48.98
| Professional | | $26.30 | $38.02 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $12.59 / $16.22
| Professional | 26 | $8.71 | $12.59 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $32.36
| Professional | TC | $17.78 | $25.70 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $52.48 / $213.80
| Facility | | $33.88 | $52.48 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $8.71 / $8.71
| Facility | 26 | $8.71 | $8.71 | $8.71 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $17.38
| Facility | TC | $16.98 | $16.98 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $30.20 / $60.26
| Professional | | $19.50 | $30.20 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $9.77 / $19.05
| Professional | 26 | $6.31 | $9.77 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $22.91 / $51.29
| Professional | TC | $15.49 | $22.91 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $128.82 / $158.49
| Facility | | $16.98 | $128.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $50.12
| Professional | | $19.95 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $7.76 / $45.71
| Professional | 26 | $6.03 | $7.76 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $19.05 / $35.48
| Professional | TC | $13.80 | $19.05 | $35.48 |