- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $45.71 / $257.04
| Professional | | $26.92 | $45.71 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $25.12 / $112.20
| Professional | 26 | $6.31 | $25.12 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $28.84 / $66.07
| Professional | TC | $20.42 | $28.84 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $87.10 / $213.80
| Professional | | $31.62 | $87.10 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $16.22 / $47.86
| Professional | 26 | $7.59 | $16.22 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $66.07 / $162.18
| Professional | TC | $23.99 | $66.07 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $30.20 / $41.69
| Facility | | $7.59 | $30.20 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $24.55 / $53.70
| Professional | | $6.17 | $24.55 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $120.23 / $177.83
| Facility | | $104.71 | $120.23 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $22.91 / $33.88
| Facility | 26 | $19.95 | $22.91 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $43.65 / $97.72
| Professional | | $15.49 | $43.65 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.16 / $8.32 / $19.95
| Professional | 26 | $3.16 | $8.32 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.30 / $34.67 / $77.62
| Professional | TC | $12.30 | $34.67 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $47.86 / $134.90
| Facility | | $27.54 | $47.86 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $100.00
| Professional | | $89.13 | $89.13 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $19.95
| Professional | 26 | $17.78 | $17.78 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $79.43
| Professional | TC | $72.44 | $72.44 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $47.86 / $144.54
| Facility | | $27.54 | $47.86 | $144.54 |
- 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
- $23.44 / $51.29 / $263.03
| Professional | | $23.44 | $51.29 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.50 / $18.20 / $144.54
| Professional | 26 | $5.50 | $18.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $43.65 / $223.87
| Professional | TC | $18.20 | $43.65 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $58.88 / $85.11
| Professional | | $32.36 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $100.00
| Professional | | $30.90 | $52.48 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $9.77 / $20.42
| Professional | 26 | $6.17 | $9.77 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $41.69 / $79.43
| Professional | TC | $24.55 | $41.69 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $208.93
| Professional | | $56.23 | $81.28 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $199.53
| Facility | | $74.13 | $74.13 | $199.53 |
- 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
- $15.49 / $234.42 / $269.15
| Professional | | $15.49 | $234.42 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.16 / $74.13 / $144.54
| Professional | 26 | $3.16 | $74.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.30 / $199.53 / $234.42
| Professional | TC | $12.30 | $199.53 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $74.13
| Professional | | $64.57 | $64.57 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $72.44
| Professional | 26 | $14.13 | $14.13 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $50.12
| Professional | TC | $18.62 | $18.62 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $89.13 / $169.82
| Professional | | $74.13 | $89.13 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $72.44 / $72.44
| Professional | 26 | $20.89 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $79.43
| Professional | TC | $18.62 | $18.62 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $72.44 / $162.18
| Professional | | $28.84 | $72.44 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $33.11 / $95.50
| Professional | 26 | $6.92 | $33.11 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $57.54 / $125.89
| Professional | TC | $21.88 | $57.54 | $125.89 |