- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $316.23 / $467.74
| Facility | | $91.20 | $316.23 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $14.13
| Facility | 26 | $7.94 | $7.94 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $46.77 / $630.96
| Facility | TC | $23.99 | $46.77 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $41.69 / $100.00
| Professional | | $7.94 | $41.69 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $15.85 / $40.74
| Professional | 26 | $7.41 | $15.85 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.38 / $64.57 / $204.17
| Professional | 50 | $17.38 | $64.57 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $3.80 / $3.80 / $3.80
| Professional | 52 | $3.80 | $3.80 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $50.12 / $208.93
| Professional | TC | $21.88 | $50.12 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $79.43 / $87.10
| Professional | | $61.66 | $79.43 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $18.62 / $20.42
| Professional | 26 | $14.45 | $18.62 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $123.03 / $158.49 / $173.78
| Professional | 50 | $123.03 | $158.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $60.26 / $67.61
| Professional | TC | $47.86 | $60.26 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $83.18
| Professional | | $32.36 | $51.29 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $11.75 / $20.42
| Professional | 26 | $8.32 | $11.75 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $39.81 / $61.66
| Professional | TC | $22.39 | $39.81 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $91.20 / $218.78
| Facility | | $33.11 | $91.20 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $91.20 / $169.82
| Facility | TC | $75.86 | $91.20 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $57.54 / $223.87
| Professional | | $31.62 | $57.54 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $16.98 / $43.65
| Professional | 26 | $12.02 | $16.98 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $41.69 / $169.82
| Professional | TC | $23.44 | $41.69 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $58.88 / $100.00
| Professional | | $31.62 | $58.88 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $14.79 / $25.70
| Professional | 26 | $8.71 | $14.79 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Professional | 50 | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $44.67 / $100.00
| Professional | TC | $23.44 | $44.67 | $100.00 |