- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $295.12 / $741.31
| Facility | | $54.95 | $295.12 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $12.02 / $117.49
| Facility | 26 | $7.24 | $12.02 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $134.90 / $524.81
| Facility | TC | $19.50 | $134.90 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $48.98 / $128.82
| Professional | | $28.84 | $48.98 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $14.45 / $38.90
| Professional | 26 | $8.51 | $14.45 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $31.62 / $67.61
| Professional | TC | $19.05 | $31.62 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $33.11 / $54.95
| Professional | | $25.70 | $33.11 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $10.47 / $19.95
| Professional | 26 | $8.13 | $10.47 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.12 / $51.29
| Professional | TC | $18.20 | $25.12 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $41.69 / $109.65
| Facility | | $19.95 | $41.69 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $31.62
| Professional | | $24.55 | $28.84 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $104.71 / $213.80
| Facility | | $61.66 | $104.71 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.63 / $12.30 / $20.89
| Facility | 26 | $2.63 | $12.30 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $31.62 / $44.67
| Facility | TC | $6.76 | $31.62 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.90 / $81.28
| Professional | | $26.30 | $38.90 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.59 / $25.12
| Professional | 26 | $7.59 | $12.59 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $60.26
| Professional | TC | $19.05 | $28.84 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $67.61 / $147.91
| Facility | | $26.30 | $67.61 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $11.75
| Facility | 26 | $11.75 | $11.75 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Facility | TC | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $34.67 / $53.70
| Professional | | $27.54 | $34.67 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $10.23 / $15.49
| Professional | 26 | $7.59 | $10.23 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $22.91 / $36.31
| Professional | TC | $18.62 | $22.91 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $26.30 / $40.74
| Professional | | $6.92 | $26.30 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $87.10 / $239.88
| Facility | | $15.85 | $87.10 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $36.31 / $79.43
| Professional | | $28.84 | $36.31 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $11.22 / $25.12
| Professional | 26 | $8.51 | $11.22 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $25.70 / $54.95
| Professional | TC | $19.50 | $25.70 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $41.69
| Professional | | $22.91 | $22.91 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $6.17 / $10.96
| Professional | 26 | $6.17 | $6.17 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $30.20
| Professional | TC | $16.60 | $16.60 | $30.20 |