- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $151.36 / $630.96
| Facility | | $35.48 | $151.36 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $15.49 / $39.81
| Facility | 26 | $7.76 | $15.49 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $45.71 / $407.38
| Facility | TC | $25.70 | $45.71 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $37.15 / $72.44
| Professional | | $26.92 | $37.15 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $14.13 / $38.90
| Professional | 26 | $7.08 | $14.13 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $48.98
| Professional | TC | $19.05 | $26.92 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $147.91 / $186.21
| Facility | | $125.89 | $147.91 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $45.71 / $70.79
| Professional | | $33.88 | $45.71 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $11.75 / $17.78
| Professional | 26 | $8.13 | $11.75 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $34.67 / $53.70
| Professional | TC | $24.55 | $34.67 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $40.74 / $112.20
| Professional | | $12.02 | $40.74 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $9.33 / $12.88
| Professional | 26 | $8.32 | $9.33 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $31.62 / $44.67
| Professional | TC | $26.92 | $31.62 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $109.65 / $524.81
| Facility | | $64.57 | $109.65 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $14.13
| Facility | 26 | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | TC | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $44.67 / $74.13
| Professional | | $28.84 | $44.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $13.18 / $22.91
| Professional | 26 | $7.08 | $13.18 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $29.51 / $56.23
| Professional | TC | $20.89 | $29.51 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $53.70
| Professional | | $34.67 | $41.69 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $12.59
| Professional | 26 | $7.94 | $10.00 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $41.69
| Professional | TC | $26.30 | $32.36 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $58.88 / $75.86
| Professional | | $46.77 | $58.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $19.05 / $20.89
| Professional | 26 | $16.98 | $19.05 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $77.62
| Facility | | $30.90 | $48.98 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $57.54
| Professional | | $39.81 | $39.81 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $33.11 / $70.79
| Facility | | $12.59 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $40.74 / $100.00
| Professional | | $14.45 | $40.74 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $15.14 / $23.99
| Professional | 26 | $9.12 | $15.14 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $33.88 / $58.88
| Professional | TC | $25.12 | $33.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $47.86 / $251.19
| Facility | | $14.13 | $47.86 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $42.66 / $74.13
| Professional | | $26.92 | $42.66 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $12.59 / $22.39
| Professional | 26 | $8.13 | $12.59 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $29.51 / $51.29
| Professional | TC | $18.62 | $29.51 | $51.29 |