- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $100.00 / $426.58
| Facility | | $56.23 | $100.00 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $22.91 / $27.54
| Facility | 26 | $14.13 | $22.91 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $72.44 / $346.74
| Facility | TC | $42.66 | $72.44 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $120.23
| Professional | | $33.88 | $51.29 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.02 / $30.20
| Professional | 26 | $8.91 | $12.02 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $177.83
| Professional | 50 | $38.02 | $38.02 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $32.36 / $70.79
| Professional | TC | $23.99 | $32.36 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $234.42 / $380.19
| Facility | | $117.49 | $234.42 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $213.80
| Facility | TC | $47.86 | $47.86 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $104.71
| Professional | | $64.57 | $75.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $20.42 / $26.92
| Professional | 26 | $17.38 | $20.42 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $54.95 / $75.86
| Professional | TC | $46.77 | $54.95 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $371.54 / $602.56
| Facility | | $147.91 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $63.10 / $89.13
| Professional | | $37.15 | $63.10 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $16.98 / $23.44
| Professional | 26 | $11.22 | $16.98 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $44.67 / $60.26
| Professional | TC | $26.92 | $44.67 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $144.54 / $144.54
| Professional | | $95.50 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Professional | 26 | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Professional | TC | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $58.88 / $138.04
| Facility | | $36.31 | $58.88 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $26.30 / $27.54
| Facility | 26 | $15.49 | $26.30 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $346.74
| Facility | TC | $47.86 | $72.44 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $72.44 / $112.20
| Professional | | $39.81 | $72.44 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $20.42 / $30.20
| Professional | 26 | $10.47 | $20.42 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $177.83
| Professional | 50 | $38.02 | $38.02 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $58.88 / $74.13
| Professional | TC | $28.84 | $58.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $31.62 / $33.11
| Professional | | $8.51 | $31.62 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $263.03 / $380.19
| Facility | | $213.80 | $263.03 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | TC | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $85.11 / $100.00
| Professional | | $66.07 | $85.11 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $21.88 / $26.30
| Professional | 26 | $17.78 | $21.88 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $63.10 / $72.44
| Professional | TC | $45.71 | $63.10 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $100.00
| Professional | | $38.90 | $38.90 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $23.44
| Professional | 26 | $10.23 | $10.23 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $31.62 / $64.57
| Professional | TC | $28.18 | $31.62 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $42.66 / $75.86
| Professional | | $38.02 | $42.66 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $12.59 / $21.88
| Professional | 26 | $11.22 | $12.59 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $30.20 / $52.48
| Professional | TC | $26.30 | $30.20 | $52.48 |