- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $295.12 / $616.60
| Facility | | $51.29 | $295.12 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.75 / $27.54
| Facility | 26 | $7.94 | $11.75 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $91.20 / $467.74
| Facility | TC | $24.55 | $91.20 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $38.90 / $120.23
| Professional | | $9.55 | $38.90 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $13.80 / $48.98
| Professional | 26 | $8.32 | $13.80 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $30.20 / $87.10 / $186.21
| Professional | 50 | $30.20 | $87.10 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $35.48 / $83.18
| Professional | TC | $20.89 | $35.48 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $28.18 / $44.67
| Professional | | $22.39 | $28.18 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $8.13 / $12.88
| Professional | 26 | $6.92 | $8.13 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $34.67 / $39.81 / $61.66
| Professional | 50 | $34.67 | $39.81 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $29.51 / $37.15
| Professional | TC | $18.62 | $29.51 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $125.89 / $389.05
| Facility | | $67.61 | $125.89 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $39.81 / $70.79
| Professional | | $11.48 | $39.81 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $77.62 / $134.90
| Facility | | $35.48 | $77.62 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $42.66 / $63.10
| Professional | | $26.92 | $42.66 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.88 / $19.50
| Professional | 26 | $7.94 | $12.88 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $30.90 / $47.86
| Professional | TC | $19.50 | $30.90 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $77.62 / $199.53
| Professional | | $38.90 | $77.62 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $15.85 / $89.13
| Professional | 26 | $10.72 | $15.85 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $38.90 / $128.82
| Professional | TC | $26.92 | $38.90 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- 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
- $100.00 / $100.00 / $100.00
| Facility | TC | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $41.69 / $45.71
| Professional | | $40.74 | $41.69 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $11.22 / $12.02
| Professional | 26 | $10.96 | $11.22 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $30.90 / $33.88
| Professional | TC | $29.51 | $30.90 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $74.13 / $208.93
| Facility | | $19.05 | $74.13 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $57.54 / $102.33
| Professional | | $31.62 | $57.54 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $14.79 / $58.88
| Professional | 26 | $9.33 | $14.79 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $39.81 / $93.33
| Professional | TC | $21.88 | $39.81 | $93.33 |