- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $446.68 / $602.56
| Facility | | $43.65 | $446.68 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $10.72
| Facility | 26 | $7.94 | $7.94 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $100.00 / $257.04
| Facility | TC | $26.92 | $100.00 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $199.53
| Professional | | $28.18 | $39.81 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $11.22 / $51.29
| Professional | 26 | $7.08 | $11.22 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $28.18 / $52.48
| Professional | TC | $20.89 | $28.18 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $28.18 / $53.70
| Professional | | $23.44 | $28.18 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $6.76 / $7.08
| Professional | 26 | $6.76 | $6.76 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $46.77 / $46.77
| Facility | | $29.51 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $56.23
| Professional | | $33.88 | $33.88 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $8.32 / $14.13
| Professional | 26 | $7.94 | $8.32 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $25.70 / $42.66
| Professional | TC | $24.55 | $25.70 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $204.17 / $676.08
| Facility | | $61.66 | $204.17 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $43.65 / $64.57
| Professional | | $30.90 | $43.65 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $13.18 / $18.20
| Professional | 26 | $8.51 | $13.18 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $48.98
| Professional | TC | $21.88 | $30.90 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $42.66 / $57.54
| Professional | | $0.28 | $42.66 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.12 / $11.22 / $14.45
| Professional | 26 | $0.12 | $11.22 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.16 / $32.36 / $43.65
| Professional | TC | $0.16 | $32.36 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.28 / $53.70
| Professional | | $0.28 | $0.28 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.12 / $0.12 / $12.88
| Professional | 26 | $0.12 | $0.12 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.16 / $0.16 / $40.74
| Professional | TC | $0.16 | $0.16 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $35.48 / $36.31
| Professional | | $33.88 | $35.48 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $8.71 / $8.91
| Professional | 26 | $8.32 | $8.71 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $26.92 / $27.54
| Professional | TC | $25.70 | $26.92 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $245.47
| Facility | | $37.15 | $37.15 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $37.15 / $60.26
| Professional | | $27.54 | $37.15 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $10.47 / $19.50
| Professional | 26 | $8.32 | $10.47 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $25.70 / $41.69
| Professional | TC | $18.62 | $25.70 | $41.69 |