- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $223.87 / $446.68
| Facility | | $48.98 | $223.87 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $7.24 / $12.30
| Facility | 26 | $6.46 | $7.24 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $120.23 / $446.68
| Facility | TC | $19.50 | $120.23 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $30.20 / $74.13
| Professional | | $7.94 | $30.20 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $11.22 / $38.02
| Professional | 26 | $7.08 | $11.22 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $15.49 / $91.20 / $123.03
| Professional | 50 | $15.49 | $91.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $53.70
| Professional | TC | $19.95 | $30.90 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $39.81
| Professional | | $20.89 | $26.92 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $7.76 / $10.47
| Professional | 26 | $6.17 | $7.76 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $32.36 / $39.81 / $64.57
| Professional | 50 | $32.36 | $39.81 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $26.30 / $31.62
| Professional | TC | $19.95 | $26.30 | $31.62 |
- 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
- $8.13 / $31.62 / $43.65
| Professional | | $8.13 | $31.62 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $107.15 / $107.15
| Facility | | $30.90 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $12.88
| Facility | 26 | $7.76 | $7.76 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $26.30
| Facility | TC | $16.98 | $16.98 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $29.51 / $47.86
| Professional | | $24.55 | $29.51 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $8.51 / $13.18
| Professional | 26 | $6.76 | $8.51 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $22.39 / $34.67
| Professional | TC | $16.98 | $22.39 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $42.66 / $269.15
| Facility | | $26.30 | $42.66 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $100.00 / $100.00
| Facility | 26 | $19.05 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $117.49 / $169.82
| Facility | TC | $54.95 | $117.49 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $35.48 / $223.87
| Professional | | $27.54 | $35.48 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $9.33 / $70.79
| Professional | 26 | $7.41 | $9.33 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $23.99 / $169.82
| Professional | TC | $19.50 | $23.99 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $70.79 / $208.93
| Facility | | $20.42 | $70.79 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $31.62 / $58.88
| Professional | | $25.70 | $31.62 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $8.32 / $15.14
| Professional | 26 | $7.41 | $8.32 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | 50 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $23.44 / $40.74
| Professional | TC | $18.62 | $23.44 | $40.74 |