- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $218.78 / $398.11
| Facility | | $107.15 | $218.78 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $19.50
| Facility | 26 | $7.94 | $7.94 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $46.77
| Facility | TC | $26.92 | $26.92 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $35.48 / $89.13
| Professional | | $11.75 | $35.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $14.13 / $37.15
| Professional | 26 | $7.08 | $14.13 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $109.65 / $138.04
| Professional | 50 | $33.11 | $109.65 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $11.22 / $23.99 / $87.10
| Professional | 52 | $11.22 | $23.99 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $69.18
| Professional | TC | $19.95 | $30.90 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $218.78 / $630.96
| Facility | | $117.49 | $218.78 | $630.96 |
- 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
- $19.50 / $23.44 / $23.44
| Facility | TC | $19.50 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $83.18 / $120.23
| Professional | | $54.95 | $83.18 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $19.95 / $28.84
| Professional | 26 | $13.18 | $19.95 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $74.13
| Professional | 52 | $63.10 | $63.10 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $93.33
| Professional | TC | $42.66 | $67.61 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $309.03
| Facility | | $79.43 | $128.82 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $28.18 / $69.18
| Facility | 26 | $12.02 | $28.18 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $97.72 / $239.88
| Facility | TC | $33.88 | $97.72 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $64.57 / $104.71
| Professional | | $33.88 | $64.57 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $14.79 / $23.99
| Professional | 26 | $9.33 | $14.79 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $50.12 / $79.43
| Professional | TC | $23.44 | $50.12 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $120.23 / $239.88
| Facility | | $97.72 | $120.23 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $27.54 / $54.95
| Facility | 26 | $22.39 | $27.54 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $93.33 / $186.21
| Facility | TC | $75.86 | $93.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $85.11
| Professional | | $51.29 | $51.29 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $19.50
| Professional | 26 | $11.75 | $11.75 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $66.07
| Professional | TC | $39.81 | $39.81 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $70.79 / $257.04
| Facility | | $34.67 | $70.79 | $257.04 |
- 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
- $131.83 / $190.55 / $316.23
| Facility | TC | $131.83 | $190.55 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $64.57 / $218.78
| Professional | | $31.62 | $64.57 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $17.38 / $58.88
| Professional | 26 | $8.71 | $17.38 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $123.03
| Professional | 52 | $50.12 | $79.43 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $38.90 / $165.96
| Professional | TC | $22.91 | $38.90 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $218.78 / $309.03
| Facility | | $14.79 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $85.11 / $245.47
| Professional | | $34.67 | $85.11 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $66.07 / $85.11
| Professional | 26 | $10.00 | $66.07 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $85.11 / $181.97
| Professional | TC | $25.70 | $85.11 | $181.97 |