- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $316.23 / $575.44
| Facility | | $100.00 | $316.23 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $63.10 / $63.10
| Facility | 26 | $28.18 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $79.43 / $199.53
| Professional | | $33.88 | $79.43 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $41.69 / $112.20
| Professional | 26 | $28.18 | $41.69 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $54.95 / $72.44 / $331.13
| Professional | 50 | $54.95 | $72.44 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $21.88 / $97.72
| Professional | TC | $15.14 | $21.88 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $53.70 / $112.20
| Professional | | $42.66 | $53.70 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $69.18 / $107.15
| Professional | 26 | $25.70 | $69.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $31.62
| Professional | TC | $16.60 | $16.60 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $97.72 / $208.93
| Facility | | $74.13 | $97.72 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $72.44 / $107.15
| Professional | | $44.67 | $72.44 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $45.71 / $63.10
| Professional | 26 | $27.54 | $45.71 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $26.92 / $38.02
| Professional | TC | $15.85 | $26.92 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $107.15 / $199.53
| Professional | | $42.66 | $107.15 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $64.57 / $83.18
| Professional | 26 | $28.18 | $64.57 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $46.77 / $89.13
| Professional | TC | $15.14 | $46.77 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $102.33 / $269.15
| Facility | | $44.67 | $102.33 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Facility | 26 | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $109.65 / $457.09
| Professional | | $63.10 | $109.65 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $45.71 / $190.55
| Professional | 26 | $31.62 | $45.71 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $56.23 / $316.23
| Professional | TC | $35.48 | $56.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $123.03 / $134.90
| Professional | | $93.33 | $123.03 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $63.10 / $81.28
| Professional | 26 | $60.26 | $63.10 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $50.12 / $72.44
| Professional | TC | $33.11 | $50.12 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $107.15 / $138.04
| Professional | | $91.20 | $107.15 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $60.26 / $74.13
| Professional | 26 | $33.88 | $60.26 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $91.20
| Professional | TC | $38.02 | $57.54 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $295.12
| Facility | | $257.04 | $257.04 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $138.04 / $218.78
| Professional | | $128.82 | $138.04 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $165.96 / $223.87
| Facility | | $31.62 | $165.96 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $95.50 / $151.36
| Professional | | $63.10 | $95.50 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $42.66 / $72.44
| Professional | 26 | $31.62 | $42.66 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $42.66 / $91.20
| Professional | TC | $31.62 | $42.66 | $91.20 |