- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $125.89 / $338.84
| Facility | | $25.12 | $125.89 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $3.02 / $3.02
| Facility | 26 | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $30.20 / $79.43
| Professional | | $18.62 | $30.20 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $8.32
| Professional | 26 | $2.00 | $3.02 | $8.32 |
- 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
- $15.85 / $21.88 / $39.81
| Professional | TC | $15.85 | $21.88 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $104.71 / $177.83
| Facility | | $50.12 | $104.71 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.95 / $2.34 / $2.34
| Facility | 26 | $1.95 | $2.34 | $2.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $57.54 / $83.18
| Professional | | $34.67 | $57.54 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.57 / $7.59 / $10.72
| Professional | 26 | $4.57 | $7.59 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $54.95 / $72.44
| Professional | TC | $32.36 | $54.95 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $208.93
| Facility | | $60.26 | $89.13 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.79 / $9.77 / $23.99
| Facility | 26 | $4.79 | $9.77 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $61.66 / $97.72
| Professional | | $30.20 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.07 / $7.59 / $11.75
| Professional | 26 | $4.07 | $7.59 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $52.48 / $85.11
| Professional | TC | $25.12 | $52.48 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $81.28 / $162.18
| Facility | | $66.07 | $81.28 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $9.55 / $19.05
| Facility | 26 | $7.76 | $9.55 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $89.13
| Professional | | $38.90 | $57.54 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.79 / $6.76 / $10.47
| Professional | 26 | $4.79 | $6.76 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $79.43
| Professional | TC | $33.88 | $51.29 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $51.29 / $74.13
| Facility | | $25.70 | $51.29 | $74.13 |
- 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
- $22.39 / $41.69 / $309.03
| Professional | | $22.39 | $41.69 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.24 / $6.03 / $128.82
| Professional | 26 | $3.24 | $6.03 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $34.67 / $251.19
| Professional | TC | $19.05 | $34.67 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $93.33 / $134.90
| Facility | | $3.02 | $93.33 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $38.02 / $74.13
| Professional | | $22.39 | $38.02 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.16 / $5.25 / $11.22
| Professional | 26 | $3.16 | $5.25 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $63.10
| Professional | TC | $19.05 | $32.36 | $63.10 |