- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $83.18 / $199.53
| Professional | | $51.29 | $83.18 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $33.88 / $114.82
| Professional | 26 | $19.95 | $33.88 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $93.33
| Professional | TC | $38.90 | $57.54 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $34.67
| Professional | | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $38.90 / $120.23
| Professional | 26 | $10.72 | $38.90 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $81.28 / $194.98
| Professional | | $41.69 | $81.28 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $37.15 / $81.28
| Professional | 26 | $26.92 | $37.15 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.48 / $47.86 / $123.03
| Professional | TC | $11.48 | $47.86 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $194.98
| Professional | | $72.44 | $93.33 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $40.74 / $89.13
| Professional | 26 | $31.62 | $40.74 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $52.48 / $107.15
| Professional | TC | $39.81 | $52.48 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $47.86 / $147.91
| Professional | | $33.88 | $47.86 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $16.98 / $63.10
| Professional | 26 | $11.48 | $16.98 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $33.11 / $100.00
| Professional | TC | $21.38 | $33.11 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $91.20 / $123.03
| Professional | | $28.84 | $91.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $25.12 / $33.88
| Professional | 26 | $22.91 | $25.12 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.75 / $66.07 / $89.13
| Professional | TC | $5.75 | $66.07 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $87.10 / $138.04
| Professional | | $70.79 | $87.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $28.84 / $38.02
| Professional | 26 | $20.42 | $28.84 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $72.44 / $100.00
| Professional | TC | $50.12 | $72.44 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Facility | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | 26 | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $588.84 / $588.84
| Professional | | $407.38 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Professional | 26 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $407.38 / $407.38
| Professional | TC | $269.15 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $89.13 / $138.04
| Facility | | $53.70 | $89.13 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $57.54 / $186.21
| Professional | | $33.88 | $57.54 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $16.98 / $63.10
| Professional | 26 | $11.48 | $16.98 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $30.90 / $107.15
| Professional | TC | $21.38 | $30.90 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 26 | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Professional | TC | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $102.33
| Professional | | $74.13 | $74.13 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $44.67 / $186.21
| Professional | | $38.02 | $44.67 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $22.39 / $91.20
| Professional | 26 | $13.49 | $22.39 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $29.51 / $120.23
| Professional | TC | $23.99 | $29.51 | $120.23 |