- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $169.82 / $371.54
| Facility | | $44.67 | $169.82 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $331.13
| Facility | TC | $269.15 | $269.15 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $61.66 / $181.97
| Professional | | $30.20 | $61.66 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $22.91 / $70.79
| Professional | 26 | $9.77 | $22.91 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $93.33
| Professional | TC | $21.88 | $28.84 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $37.15
| Professional | | $18.62 | $18.62 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.68 / $6.46 / $10.23
| Professional | 26 | $4.68 | $6.46 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $26.92
| Professional | TC | $26.92 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $112.20
| Professional | | $32.36 | $50.12 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $18.20 / $60.26
| Professional | 26 | $10.00 | $18.20 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $35.48 / $61.66
| Professional | TC | $22.39 | $35.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $100.00
| Professional | | $37.15 | $48.98 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $12.59 / $20.42
| Professional | 26 | $9.77 | $12.59 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $35.48 / $77.62
| Professional | TC | $27.54 | $35.48 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $29.51 / $144.54
| Professional | | $19.05 | $29.51 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $9.33 / $128.82
| Professional | 26 | $5.25 | $9.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $24.55 / $120.23
| Professional | TC | $13.80 | $24.55 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $51.29 / $131.83
| Facility | | $35.48 | $51.29 | $131.83 |
- 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
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Facility | TC | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $74.13 / $363.08
| Professional | | $25.12 | $74.13 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $15.85 / $190.55
| Professional | 26 | $7.08 | $15.85 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $50.12 / $269.15
| Professional | TC | $17.78 | $50.12 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $15.49 / $20.89
| Facility | | $5.37 | $15.49 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $100.00
| Professional | | $25.12 | $41.69 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.02 / $28.84
| Professional | 26 | $7.08 | $12.02 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $30.20 / $75.86
| Professional | TC | $17.78 | $30.20 | $75.86 |