- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $263.03 / $416.87
| Facility | | $134.90 | $263.03 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $14.45
| Facility | 26 | $7.94 | $7.94 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $60.26
| Facility | TC | $19.95 | $19.95 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $79.43
| Professional | | $22.91 | $36.31 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $11.48 / $29.51
| Professional | 26 | $7.76 | $11.48 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $60.26
| Professional | TC | $15.85 | $23.99 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $251.19 / $758.58
| Facility | | $141.25 | $251.19 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $7.08 / $7.08
| Facility | 26 | $5.89 | $7.08 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $17.38 / $17.38
| Facility | TC | $14.45 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $69.18 / $100.00
| Professional | | $45.71 | $69.18 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $20.89 / $30.20
| Professional | 26 | $13.80 | $20.89 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $52.48 / $70.79
| Professional | TC | $33.11 | $52.48 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $104.71 / $251.19
| Facility | | $66.07 | $104.71 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $29.51 / $72.44
| Facility | 26 | $12.59 | $29.51 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $72.44 / $177.83
| Facility | TC | $25.70 | $72.44 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $53.70 / $89.13
| Professional | | $31.62 | $53.70 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $15.49 / $25.12
| Professional | 26 | $9.77 | $15.49 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $38.02 / $60.26
| Professional | TC | $21.38 | $38.02 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $100.00 / $194.98
| Facility | | $79.43 | $100.00 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $56.23
| Facility | 26 | $22.91 | $28.84 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $70.79 / $138.04
| Facility | TC | $57.54 | $70.79 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $75.86
| Professional | | $41.69 | $41.69 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $12.30 / $20.42
| Professional | 26 | $12.30 | $12.30 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $50.12
| Professional | TC | $30.20 | $30.20 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $83.18 / $275.42
| Facility | | $33.88 | $83.18 | $275.42 |
- 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
- $158.49 / $199.53 / $288.40
| Facility | TC | $158.49 | $199.53 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $61.66 / $177.83
| Professional | | $27.54 | $61.66 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $20.89 / $77.62
| Professional | 26 | $10.00 | $20.89 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $36.31 / $162.18
| Professional | TC | $19.05 | $36.31 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $263.03 / $371.54
| Facility | | $15.49 | $263.03 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $85.11 / $213.80
| Professional | | $31.62 | $85.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $67.61 / $85.11
| Professional | 26 | $10.47 | $67.61 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $85.11 / $147.91
| Professional | TC | $21.88 | $85.11 | $147.91 |