- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $60.26
| Facility | | $43.65 | $43.65 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $37.15
| Facility | 26 | $28.18 | $28.18 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $54.95 / $218.78
| Professional | | $38.90 | $54.95 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $33.11 / $81.28
| Professional | 26 | $25.12 | $33.11 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $57.54 / $331.13 / $338.84
| Professional | 50 | $57.54 | $331.13 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $21.88 / $63.10
| Professional | TC | $12.88 | $21.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Professional | 26 | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Facility | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Professional | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $83.18 / $141.25
| Professional | | $42.66 | $83.18 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $34.67 / $58.88
| Professional | 26 | $26.30 | $34.67 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $46.77 / $89.13
| Professional | TC | $15.49 | $46.77 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $32.36 / $33.11
| Professional | | $24.55 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $239.88 / $346.74
| Facility | | $165.96 | $239.88 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $74.13 / $102.33
| Professional | | $53.70 | $74.13 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $30.90 / $39.81
| Professional | 26 | $26.30 | $30.90 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $39.81 / $64.57
| Professional | TC | $26.30 | $39.81 | $64.57 |