- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $14.79 / $44.67
| Professional | | $10.00 | $14.79 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $6.92 / $22.91
| Professional | 26 | $3.02 | $6.92 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.08 / $10.00 / $31.62
| Professional | TC | $7.08 | $10.00 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $7.41 / $8.32
| Professional | | $7.24 | $7.41 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.95 / $2.04 / $7.76
| Professional | 26 | $1.95 | $2.04 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.37 / $5.37 / $7.24
| Professional | TC | $5.37 | $5.37 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $15.49 / $33.88
| Professional | | $7.24 | $15.49 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.19 / $4.68 / $7.59
| Professional | 26 | $2.19 | $4.68 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.13 / $10.72 / $26.92
| Professional | TC | $5.13 | $10.72 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.96 / $20.42
| Facility | | $10.23 | $10.96 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.95 / $2.04 / $3.80
| Facility | 26 | $1.95 | $2.04 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.47 / $36.31
| Professional | | $7.08 | $10.47 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.04 / $3.16 / $8.32
| Professional | 26 | $2.04 | $3.16 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.90 / $7.08 / $19.50
| Professional | TC | $4.90 | $7.08 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $100.00
| Facility | | $95.50 | $95.50 | $100.00 |
- 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
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $141.25 / $141.25
| Professional | | $125.89 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Professional | 26 | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $104.71 / $104.71
| Professional | TC | $100.00 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $14.13 / $34.67
| Professional | | $8.32 | $14.13 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.45 / $4.17 / $10.23
| Professional | 26 | $2.45 | $4.17 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.75 / $10.00 / $24.55
| Professional | TC | $5.75 | $10.00 | $24.55 |