- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $87.10 / $302.00
| Facility | | $33.88 | $87.10 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $12.02 / $30.90
| Facility | 26 | $6.03 | $12.02 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $64.57 / $281.84
| Facility | TC | $15.14 | $64.57 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $33.88 / $117.49
| Professional | | $15.14 | $33.88 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $15.85 / $35.48
| Professional | 26 | $7.08 | $15.85 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $125.89 / $295.12
| Professional | 50 | $33.11 | $125.89 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $16.22 / $25.12 / $46.77
| Professional | 52 | $16.22 | $25.12 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $26.30 / $61.66
| Professional | TC | $15.85 | $26.30 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $102.33 / $363.08
| Facility | | $30.90 | $102.33 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $100.00 / $100.00
| Facility | 26 | $19.05 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $158.49 / $158.49
| Facility | TC | $61.66 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $41.69 / $208.93
| Professional | | $25.70 | $41.69 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $70.79
| Professional | 26 | $7.08 | $10.96 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $158.49
| Professional | TC | $19.95 | $33.11 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $109.65 / $141.25
| Facility | | $70.79 | $109.65 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $15.14 / $19.95
| Professional | 26 | $8.71 | $15.14 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $4.37 / $11.48 / $42.66
| Professional | 52 | $4.37 | $11.48 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $45.71
| Professional | TC | $30.90 | $30.90 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $169.82 / $275.42
| Facility | | $63.10 | $169.82 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Facility | TC | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $46.77 / $89.13
| Professional | | $25.12 | $46.77 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $11.75 / $22.39
| Professional | 26 | $6.46 | $11.75 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $36.31 / $66.07
| Professional | TC | $19.50 | $36.31 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $34.67 / $74.13
| Facility | | $10.23 | $34.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $34.67 / $58.88
| Professional | | $10.23 | $34.67 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $51.29 / $102.33
| Professional | | $33.11 | $51.29 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $11.75 / $20.89
| Professional | 26 | $8.32 | $11.75 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $35.48 / $67.61
| Professional | TC | $25.12 | $35.48 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $50.12 / $194.98
| Facility | | $23.44 | $50.12 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.49 / $151.36
| Professional | | $10.96 | $15.49 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $102.33 / $363.08
| Facility | | $30.90 | $102.33 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $100.00 / $100.00
| Facility | 26 | $19.05 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $158.49 / $158.49
| Facility | TC | $61.66 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $41.69 / $208.93
| Professional | | $25.70 | $41.69 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $70.79
| Professional | 26 | $7.08 | $10.96 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $158.49
| Professional | TC | $19.95 | $33.11 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $79.43 / $288.40
| Facility | | $12.30 | $79.43 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $102.33
| Professional | | $30.20 | $44.67 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $11.22 / $26.30
| Professional | 26 | $7.76 | $11.22 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $33.11 / $75.86
| Professional | TC | $22.39 | $33.11 | $75.86 |