- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $97.72 / $245.47
| Facility | | $20.89 | $97.72 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $2.00
| Facility | 26 | $2.00 | $2.00 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $32.36 / $85.11
| Professional | | $18.20 | $32.36 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.98 / $18.62
| Professional | 26 | $2.00 | $3.98 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $16.60 / $21.88 / $36.31
| Professional | 52 | $16.60 | $21.88 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $22.91 / $60.26
| Professional | TC | $15.14 | $22.91 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $83.18 / $147.91
| Facility | | $57.54 | $83.18 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $7.41 / $100.00
| Facility | 26 | $6.61 | $7.41 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $41.69 / $323.59
| Professional | | $20.89 | $41.69 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $6.17 / $128.82
| Professional | 26 | $3.02 | $6.17 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $36.31 / $263.03
| Professional | TC | $19.05 | $36.31 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $100.00 / $131.83
| Facility | | $81.28 | $100.00 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Professional | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $8.51 / $8.51
| Professional | 26 | $8.51 | $8.51 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $4.27 / $4.27 / $35.48
| Professional | 52 | $4.27 | $4.27 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Professional | TC | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $40.74 / $75.86
| Professional | | $19.05 | $40.74 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.69 / $5.89 / $13.18
| Professional | 26 | $2.69 | $5.89 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $33.88 / $66.07
| Professional | TC | $16.60 | $33.88 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $17.78 / $45.71
| Facility | | $2.24 | $17.78 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $16.60 / $39.81
| Professional | | $2.19 | $16.60 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $47.86 / $77.62
| Professional | | $24.55 | $47.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.24 / $4.90 / $8.51
| Professional | 26 | $3.24 | $4.90 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $32.36 / $57.54
| Professional | TC | $21.38 | $32.36 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $165.96 / $165.96
| Facility | | $141.25 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $7.59 / $7.59
| Professional | | $7.59 | $7.59 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $83.18 / $147.91
| Facility | | $57.54 | $83.18 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $7.41 / $100.00
| Facility | 26 | $6.61 | $7.41 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $41.69 / $323.59
| Professional | | $20.89 | $41.69 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $6.17 / $128.82
| Professional | 26 | $3.02 | $6.17 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $36.31 / $263.03
| Professional | TC | $19.05 | $36.31 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $28.18
| Professional | | $26.92 | $26.92 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $52.48 / $138.04
| Facility | | $6.92 | $52.48 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $40.74 / $74.13
| Professional | | $22.39 | $40.74 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.24 / $5.50 / $11.75
| Professional | 26 | $3.24 | $5.50 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $61.66
| Professional | TC | $19.05 | $32.36 | $61.66 |