- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $269.15 / $407.38
| Facility | | $50.12 | $269.15 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $21.88 / $25.70
| Facility | 26 | $12.59 | $21.88 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $323.59 / $407.38
| Facility | TC | $45.71 | $323.59 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $44.67 / $100.00
| Professional | | $28.84 | $44.67 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $15.14 / $29.51
| Professional | 26 | $8.91 | $15.14 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $30.90 / $53.70
| Professional | TC | $19.05 | $30.90 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $204.17 / $331.13
| Facility | | $107.15 | $204.17 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $213.80
| Facility | TC | $37.15 | $37.15 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $60.26 / $83.18
| Professional | | $51.29 | $60.26 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $18.20 / $24.55
| Professional | 26 | $15.49 | $18.20 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $41.69 / $57.54
| Professional | TC | $35.48 | $41.69 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $371.54 / $602.56
| Facility | | $147.91 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $50.12 / $81.28
| Professional | | $33.11 | $50.12 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $15.49 / $23.44
| Professional | 26 | $11.22 | $15.49 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $33.88 / $51.29
| Professional | TC | $21.38 | $33.88 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $112.20
| Professional | | $104.71 | $104.71 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Professional | 26 | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $39.81
| Professional | TC | $32.36 | $32.36 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $60.26 / $269.15
| Facility | | $30.20 | $60.26 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $24.55 / $26.30
| Facility | 26 | $14.13 | $24.55 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $109.65 / $398.11
| Facility | TC | $45.71 | $109.65 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $63.10 / $93.33
| Professional | | $33.88 | $63.10 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $19.05 / $26.92
| Professional | 26 | $10.00 | $19.05 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $44.67 / $57.54
| Professional | TC | $23.99 | $44.67 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $25.12 / $33.11
| Professional | | $7.76 | $25.12 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $263.03 / $380.19
| Facility | | $213.80 | $263.03 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | TC | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $67.61 / $79.43
| Professional | | $54.95 | $67.61 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $23.99
| Professional | 26 | $15.85 | $19.95 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $47.86 / $54.95
| Professional | TC | $38.02 | $47.86 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $31.62 / $70.79
| Professional | | $30.90 | $31.62 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $21.38
| Professional | 26 | $9.33 | $9.33 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $25.70 / $48.98
| Professional | TC | $21.38 | $25.70 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $36.31 / $63.10
| Professional | | $32.36 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $11.48 / $20.89
| Professional | 26 | $10.47 | $11.48 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $23.99 / $43.65
| Professional | TC | $21.88 | $23.99 | $43.65 |