- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $218.78 / $478.63
| Facility | | $43.65 | $218.78 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $17.38 / $239.88
| Facility | 26 | $9.12 | $17.38 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $91.20 / $407.38
| Facility | TC | $22.39 | $91.20 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $48.98 / $158.49
| Professional | | $28.18 | $48.98 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $14.45 / $46.77
| Professional | 26 | $9.33 | $14.45 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $64.57
| Professional | TC | $19.05 | $28.84 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $27.54 / $38.02
| Professional | | $20.89 | $27.54 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $10.23 / $14.79
| Professional | 26 | $7.76 | $10.23 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $25.12 / $32.36
| Professional | TC | $14.79 | $25.12 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $245.47
| Facility | | $72.44 | $104.71 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $38.90 / $75.86
| Professional | | $13.18 | $38.90 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $218.78
| Facility | | $45.71 | $70.79 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $41.69 / $63.10
| Professional | | $26.30 | $41.69 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $14.45 / $21.38
| Professional | 26 | $8.71 | $14.45 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $28.18 / $42.66
| Professional | TC | $17.78 | $28.18 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $67.61 / $223.87
| Professional | | $39.81 | $67.61 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $15.85 / $61.66
| Professional | 26 | $11.48 | $15.85 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $39.81 / $165.96
| Professional | TC | $23.44 | $39.81 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | TC | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $40.74 / $43.65
| Professional | | $39.81 | $40.74 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $12.59 / $13.49
| Professional | 26 | $11.48 | $12.59 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $28.18 / $30.20
| Professional | TC | $26.92 | $28.18 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $74.13 / $208.93
| Facility | | $19.95 | $74.13 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $52.48 / $120.23
| Professional | | $31.62 | $52.48 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $16.22 / $63.10
| Professional | 26 | $10.96 | $16.22 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $36.31 / $95.50
| Professional | TC | $20.89 | $36.31 | $95.50 |