- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $199.53 / $501.19
| Facility | | $43.65 | $199.53 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $58.88
| Facility | 26 | $18.20 | $26.30 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $229.09 / $407.38
| Facility | TC | $18.62 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $69.18 / $144.54
| Professional | | $32.36 | $69.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $50.12 / $70.79 / $70.79
| Professional | 25 | $50.12 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $64.57
| Professional | 26 | $18.20 | $25.70 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $81.28 / $234.42 / $338.84
| Professional | 50 | $81.28 | $234.42 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $30.20 / $41.69 / $100.00
| Professional | 52 | $30.20 | $41.69 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $25.70 / $93.33
| Professional | TC | $12.88 | $25.70 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $4,365.16 / $12,022.64
| Facility | | $1,659.59 | $4,365.16 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $63.10 / $120.23
| Professional | | $30.90 | $63.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $25.12 / $50.12
| Professional | 26 | $16.60 | $25.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $46.77 / $87.10 / $173.78
| Professional | 50 | $46.77 | $87.10 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $34.67 / $79.43
| Professional | TC | $14.45 | $34.67 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $117.49 / $323.59
| Facility | | $57.54 | $117.49 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $26.30 / $74.13
| Facility | 26 | $5.01 | $26.30 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.80 / $20.42 / $61.66
| Facility | TC | $3.80 | $20.42 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $77.62 / $138.04
| Professional | | $37.15 | $77.62 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $58.88
| Professional | 26 | $19.05 | $30.20 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $45.71 / $85.11
| Professional | TC | $16.60 | $45.71 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $138.04 / $446.68
| Facility | | $24.55 | $138.04 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $57.54 / $114.82
| Professional | | $37.15 | $57.54 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $47.86
| Professional | 26 | $17.78 | $25.70 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $69.18
| Professional | TC | $19.05 | $32.36 | $69.18 |