- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $186.21 / $501.19
| Facility | | $38.02 | $186.21 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $20.89
| Facility | 26 | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $72.44 / $489.78
| Facility | TC | $15.85 | $72.44 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $70.79 / $144.54
| Professional | | $37.15 | $70.79 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Professional | 25 | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $66.07
| Professional | 26 | $19.05 | $23.99 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $338.84
| Professional | 50 | $234.42 | $234.42 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $70.79
| Professional | 52 | $38.02 | $38.02 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $25.70 / $93.33
| Professional | TC | $15.14 | $25.70 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $34.67 / $37.15
| Professional | | $28.84 | $34.67 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $54.95 / $72.44
| Professional | | $33.11 | $54.95 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $23.99 / $40.74
| Professional | 26 | $17.78 | $23.99 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $39.81 / $57.54 / $93.33
| Professional | 50 | $39.81 | $57.54 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $25.12 / $42.66
| Professional | TC | $15.14 | $25.12 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $67.61 / $109.65
| Professional | | $37.15 | $67.61 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $27.54 / $38.02
| Professional | 26 | $20.42 | $27.54 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $37.15 / $69.18
| Professional | TC | $16.60 | $37.15 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $47.86 / $67.61
| Professional | | $1.15 | $47.86 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.65 / $24.55 / $32.36
| Professional | 26 | $0.65 | $24.55 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.51 / $21.88 / $40.74
| Professional | TC | $0.51 | $21.88 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.15 / $1.15 / $54.95
| Professional | | $1.15 | $1.15 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.65 / $0.65 / $30.20
| Professional | 26 | $0.65 | $0.65 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.51 / $0.51 / $25.12
| Professional | TC | $0.51 | $0.51 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $37.15 / $38.02
| Professional | | $35.48 | $37.15 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $20.42 / $20.89
| Professional | 26 | $19.50 | $20.42 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $16.60 / $16.60
| Professional | TC | $15.85 | $16.60 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Facility | | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $56.23 / $95.50
| Professional | | $30.90 | $56.23 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $40.74
| Professional | 26 | $17.78 | $25.70 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $42.66 / $67.61
| Professional | TC | $19.05 | $42.66 | $67.61 |