- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $194.98 / $239.88
| Facility | | $72.44 | $194.98 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $70.79 / $81.28
| Facility | 26 | $61.66 | $70.79 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $77.62 / $173.78
| Professional | | $38.90 | $77.62 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $41.69 / $100.00
| Professional | 26 | $25.70 | $41.69 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $104.71 / $223.87 / $467.74
| Professional | 50 | $104.71 | $223.87 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $23.99 / $46.77
| Professional | TC | $14.13 | $23.99 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $229.09 / $257.04
| Facility | | $186.21 | $229.09 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $67.61 / $141.25
| Professional | | $48.98 | $67.61 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $69.18
| Professional | 26 | $30.20 | $42.66 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $72.44 / $102.33 / $165.96
| Professional | 50 | $72.44 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $52.48
| Professional | TC | $18.20 | $25.70 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $97.72 / $158.49
| Professional | | $58.88 | $97.72 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $56.23 / $85.11
| Professional | 26 | $32.36 | $56.23 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $40.74 / $87.10
| Professional | TC | $16.98 | $40.74 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Facility | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $72.44 / $138.04
| Professional | | $38.02 | $72.44 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $57.54 / $87.10
| Professional | 26 | $36.31 | $57.54 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $28.18 / $52.48
| Professional | TC | $21.38 | $28.18 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $72.44 / $158.49
| Professional | | $42.66 | $72.44 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $42.66 / $89.13
| Professional | 26 | $28.18 | $42.66 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $29.51 / $70.79
| Professional | TC | $15.14 | $29.51 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $85.11 / $141.25
| Professional | | $53.70 | $85.11 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $85.11
| Professional | 26 | $32.36 | $51.29 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $35.48 / $58.88
| Professional | TC | $20.42 | $35.48 | $58.88 |