- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $85.11 / $257.04
| Facility | | $21.88 | $85.11 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.89 / $14.79
| Facility | 26 | $2.00 | $3.89 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $29.51 / $81.28
| Professional | | $18.20 | $29.51 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $15.14
| Professional | 26 | $2.00 | $3.02 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $77.62 / $229.09
| Professional | 50 | $69.18 | $77.62 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $16.60 / $36.31 / $41.69
| Professional | 52 | $16.60 | $36.31 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $21.88 / $44.67
| Professional | TC | $15.14 | $21.88 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $134.90 / $165.96
| Facility | | $11.48 | $134.90 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $34.67 / $72.44
| Professional | | $19.50 | $34.67 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.75 / $5.62 / $18.62
| Professional | 26 | $2.75 | $5.62 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $104.71
| Professional | 50 | $28.84 | $47.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $27.54 / $57.54
| Professional | TC | $16.22 | $27.54 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $72.44 / $173.78
| Facility | | $35.48 | $72.44 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.72 / $3.89 / $9.77
| Facility | 26 | $0.72 | $3.89 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $38.02 / $74.13
| Professional | | $20.42 | $38.02 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.88 / $5.50 / $14.13
| Professional | 26 | $2.88 | $5.50 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $30.90 / $60.26
| Professional | TC | $17.78 | $30.90 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $48.98 / $125.89
| Facility | | $10.72 | $48.98 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $61.66
| Professional | | $19.05 | $30.20 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $4.37 / $12.88
| Professional | 26 | $2.82 | $4.37 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $25.12 / $47.86
| Professional | TC | $16.22 | $25.12 | $47.86 |