- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $263.03 / $691.83
| Facility | | $38.02 | $263.03 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $32.36 / $83.18
| Facility | 26 | $10.23 | $32.36 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $64.57 / $263.03
| Facility | TC | $33.11 | $64.57 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $39.81 / $112.20
| Professional | | $9.55 | $39.81 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $13.49 / $48.98
| Professional | 26 | $8.13 | $13.49 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $34.67 / $83.18 / $190.55
| Professional | 50 | $34.67 | $83.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $34.67 / $83.18
| Professional | TC | $19.95 | $34.67 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $27.54 / $38.90
| Professional | | $22.39 | $27.54 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $7.08 / $12.02
| Professional | 26 | $5.89 | $7.08 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $34.67 / $40.74 / $58.88
| Professional | 50 | $34.67 | $40.74 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $21.38 / $29.51
| Professional | TC | $15.85 | $21.38 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $75.86 / $128.82
| Facility | | $19.50 | $75.86 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $147.91
| Professional | | $30.20 | $35.48 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $8.91 / $14.45
| Professional | 26 | $7.24 | $8.91 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $27.54 / $112.20
| Professional | TC | $22.91 | $27.54 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $114.82 / $269.15
| Facility | | $60.26 | $114.82 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.19 / $10.23 / $14.79
| Facility | 26 | $2.19 | $10.23 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.03 / $28.18 / $39.81
| Facility | TC | $6.03 | $28.18 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $36.31 / $67.61
| Professional | | $26.92 | $36.31 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $10.47 / $19.95
| Professional | 26 | $7.59 | $10.47 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $25.12 / $50.12
| Professional | TC | $18.62 | $25.12 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $177.83
| Facility | | $30.20 | $40.74 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $100.00 / $100.00
| Facility | 26 | $20.89 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $117.49 / $117.49
| Facility | TC | $54.95 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $35.48 / $223.87
| Professional | | $28.84 | $35.48 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $10.72 / $89.13
| Professional | 26 | $8.71 | $10.72 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $25.12 / $177.83
| Professional | TC | $19.50 | $25.12 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $74.13 / $95.50
| Facility | | $15.85 | $74.13 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $33.88 / $89.13
| Professional | | $28.84 | $33.88 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $10.00 / $58.88
| Professional | 26 | $8.51 | $10.00 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $23.99 / $75.86
| Professional | TC | $19.50 | $23.99 | $75.86 |