- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $275.42 / $512.86
| Facility | | $33.88 | $275.42 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $9.33 / $11.48
| Facility | 26 | $6.03 | $9.33 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $28.18 / $177.83
| Facility | TC | $15.49 | $28.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $28.84 / $64.57
| Professional | | $17.38 | $28.84 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.00 / $35.48
| Professional | 26 | $6.03 | $10.00 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Professional | 50 | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $21.88 / $23.44 / $28.18
| Professional | 52 | $21.88 | $23.44 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $21.88 / $47.86
| Professional | TC | $15.14 | $21.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $22.39 / $30.90
| Professional | | $17.78 | $22.39 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.50 / $9.33 / $10.00
| Professional | 26 | $5.50 | $9.33 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Professional | 50 | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $21.38 / $32.36
| Professional | TC | $14.45 | $21.38 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $102.33
| Facility | | $51.29 | $72.44 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $26.30 / $36.31
| Professional | | $7.41 | $26.30 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $87.10 / $87.10
| Facility | | $28.18 | $87.10 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $11.75
| Facility | 26 | $7.08 | $7.08 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $23.99
| Facility | TC | $14.13 | $14.13 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $25.70 / $41.69
| Professional | | $20.89 | $25.70 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $7.76 / $12.30
| Professional | 26 | $6.17 | $7.76 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $18.62 / $29.51
| Professional | TC | $14.13 | $18.62 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $34.67 / $208.93
| Facility | | $21.38 | $34.67 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $100.00 / $100.00
| Facility | 26 | $17.38 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $100.00 / $138.04
| Facility | TC | $44.67 | $100.00 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $30.20 / $181.97
| Professional | | $23.44 | $30.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $8.32 / $67.61
| Professional | 26 | $6.76 | $8.32 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $154.88
| Professional | TC | $15.85 | $19.95 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $70.79 / $208.93
| Facility | | $16.98 | $70.79 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $26.92 / $44.67
| Professional | | $22.39 | $26.92 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $7.59 / $15.49
| Professional | 26 | $6.76 | $7.59 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $32.36
| Professional | TC | $15.85 | $19.05 | $32.36 |