- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $147.91 / $389.05
| Facility | | $39.81 | $147.91 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $14.45 / $24.55
| Facility | 26 | $10.23 | $14.45 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $34.67 / $93.33
| Professional | | $14.79 | $34.67 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.79 / $35.48
| Professional | 26 | $8.91 | $14.79 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $28.18 / $58.88
| Professional | TC | $19.50 | $28.18 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $61.66
| Professional | | $21.88 | $33.88 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $17.38
| Professional | 26 | $7.94 | $7.94 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $15.49
| Professional | TC | $15.49 | $15.49 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $38.90 / $63.10
| Professional | | $31.62 | $38.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $13.80 / $21.88
| Professional | 26 | $10.96 | $13.80 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $25.12 / $42.66
| Professional | TC | $20.42 | $25.12 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $30.90 / $58.88
| Facility | | $24.55 | $30.90 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $39.81 / $48.98
| Professional | | $37.15 | $39.81 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $11.48 / $15.85
| Professional | 26 | $11.22 | $11.48 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $27.54 / $34.67
| Professional | TC | $25.70 | $27.54 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $89.13 / $245.47
| Facility | | $53.70 | $89.13 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.63 / $12.30 / $17.38
| Facility | 26 | $2.63 | $12.30 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $43.65 / $70.79
| Professional | | $28.18 | $43.65 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $14.45 / $25.70
| Professional | 26 | $9.12 | $14.45 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $29.51 / $56.23
| Professional | TC | $19.05 | $29.51 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $107.15
| Facility | | $32.36 | $50.12 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $100.00 / $100.00
| Facility | 26 | $25.12 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $47.86 / $234.42
| Professional | | $31.62 | $47.86 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $15.49 / $83.18
| Professional | 26 | $10.72 | $15.49 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $31.62 / $190.55
| Professional | TC | $20.89 | $31.62 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $74.13 / $177.83
| Facility | | $32.36 | $74.13 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $39.81 / $75.86
| Professional | | $31.62 | $39.81 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $13.18 / $38.90
| Professional | 26 | $10.47 | $13.18 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $53.70
| Professional | TC | $20.89 | $26.30 | $53.70 |