- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $66.07 / $269.15
| Facility | | $47.86 | $66.07 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $6.03 / $6.03
| Facility | 26 | $2.00 | $6.03 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $34.67 / $47.86
| Professional | | $20.89 | $34.67 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $4.07 / $7.08
| Professional | 26 | $2.00 | $4.07 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $47.86
| Professional | TC | $16.98 | $21.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $53.70
| Professional | | $43.65 | $43.65 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $97.72 / $186.21
| Facility | | $74.13 | $97.72 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $45.71
| Professional | | $20.42 | $33.11 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.57 / $4.27 / $5.89
| Professional | 26 | $2.57 | $4.27 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $28.84 / $40.74
| Professional | TC | $17.78 | $28.84 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $48.98 / $70.79
| Professional | | $28.18 | $48.98 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.27 / $6.76 / $12.88
| Professional | 26 | $4.27 | $6.76 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $42.66 / $53.70
| Professional | TC | $23.99 | $42.66 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $41.69 / $120.23
| Facility | | $26.30 | $41.69 | $120.23 |
- 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
- $23.99 / $40.74 / $309.03
| Professional | | $23.99 | $40.74 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.63 / $6.31 / $128.82
| Professional | 26 | $3.63 | $6.31 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $251.19
| Professional | TC | $20.42 | $33.11 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $47.86 / $54.95
| Professional | | $39.81 | $47.86 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $6.46 / $7.76
| Professional | 26 | $5.62 | $6.46 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $40.74 / $47.86
| Professional | TC | $33.88 | $40.74 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $50.12 / $58.88
| Professional | | $48.98 | $50.12 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $7.76 / $12.88
| Professional | 26 | $6.46 | $7.76 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $43.65 / $50.12
| Professional | TC | $36.31 | $43.65 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $22.91 / $47.86
| Professional | | $3.47 | $22.91 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $47.86 / $63.10
| Facility | | $11.75 | $47.86 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $37.15 / $58.88
| Professional | | $23.99 | $37.15 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.24 / $5.25 / $16.60
| Professional | 26 | $3.24 | $5.25 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $46.77
| Professional | TC | $19.50 | $27.54 | $46.77 |