- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $213.80 / $389.05
| Facility | | $51.29 | $213.80 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $13.49 / $15.85
| Facility | 26 | $6.03 | $13.49 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $56.23 / $269.15
| Facility | TC | $18.62 | $56.23 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $33.11 / $128.82
| Professional | | $10.23 | $33.11 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $13.80 / $43.65
| Professional | 26 | $7.08 | $13.80 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.78 / $117.49 / $144.54
| Professional | 50 | $17.78 | $117.49 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $29.51 / $117.49
| Professional | TC | $16.98 | $29.51 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Facility | 26 | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | TC | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $69.18 / $87.10
| Professional | | $28.18 | $69.18 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $17.38 / $21.88
| Professional | 26 | $7.76 | $17.38 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $52.48 / $66.07
| Professional | TC | $20.42 | $52.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $47.86 / $102.33
| Professional | | $26.30 | $47.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $13.80 / $53.70
| Professional | 26 | $7.24 | $13.80 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $33.88 / $70.79
| Professional | TC | $19.05 | $33.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $72.44 / $346.74
| Facility | | $35.48 | $72.44 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $100.00 / $100.00
| Facility | 26 | $25.12 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $144.54
| Facility | TC | $64.57 | $100.00 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $48.98 / $186.21
| Professional | | $26.92 | $48.98 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $12.30 / $64.57
| Professional | 26 | $8.13 | $12.30 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $25.12 / $162.18
| Professional | TC | $17.78 | $25.12 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $63.10 / $95.50
| Professional | | $54.95 | $63.10 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $19.05 / $25.70
| Professional | 26 | $15.49 | $19.05 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $69.18
| Professional | TC | $39.81 | $46.77 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Facility | 26 | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | TC | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $69.18 / $72.44
| Professional | | $57.54 | $69.18 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $19.05 / $22.91
| Professional | 26 | $16.22 | $19.05 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $51.29 / $53.70
| Professional | TC | $40.74 | $51.29 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $1,380.38 / $1,949.84
| Facility | | $138.04 | $1,380.38 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $22.39 / $48.98
| Professional | | $7.94 | $22.39 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $190.55 / $245.47
| Facility | | $109.65 | $190.55 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $39.81 / $100.00
| Professional | | $26.92 | $39.81 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $13.49 / $50.12
| Professional | 26 | $8.13 | $13.49 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $27.54 / $79.43
| Professional | TC | $18.62 | $27.54 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $58.88
| Professional | | $50.12 | $50.12 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $15.49
| Professional | 26 | $13.18 | $13.18 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $43.65
| Professional | TC | $37.15 | $37.15 | $43.65 |