- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $269.15 / $489.78
| Facility | | $48.98 | $269.15 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.98 / $75.86
| Facility | 26 | $10.00 | $16.98 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $77.62 / $281.84
| Facility | TC | $37.15 | $77.62 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $30.20 / $112.20
| Professional | | $8.91 | $30.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $13.80 / $30.20
| Professional | 26 | $7.08 | $13.80 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $31.62 / $58.88
| Professional | TC | $18.20 | $31.62 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $48.98 / $74.13
| Professional | | $25.12 | $48.98 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $14.79 / $17.38
| Professional | 26 | $7.94 | $14.79 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $39.81 / $44.67
| Professional | TC | $36.31 | $39.81 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $181.97 / $380.19
| Facility | | $144.54 | $181.97 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $57.54 / $60.26
| Professional | | $53.70 | $57.54 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $14.45 / $15.85
| Professional | 26 | $13.49 | $14.45 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $42.66 / $45.71
| Professional | TC | $39.81 | $42.66 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $323.59
| Facility | | $173.78 | $173.78 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | 26 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | TC | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $66.07 / $95.50
| Professional | | $24.55 | $66.07 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $16.98 / $22.39
| Professional | 26 | $9.12 | $16.98 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $48.98 / $74.13
| Professional | TC | $22.39 | $48.98 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $128.82 / $363.08
| Facility | | $37.15 | $128.82 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $100.00 / $100.00
| Facility | 26 | $21.38 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $478.63
| Facility | TC | $109.65 | $109.65 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $47.86 / $204.17
| Professional | | $31.62 | $47.86 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $14.45 / $74.13
| Professional | 26 | $9.77 | $14.45 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $33.11 / $177.83
| Professional | TC | $23.44 | $33.11 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $67.61 / $109.65
| Professional | | $60.26 | $67.61 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $16.98 / $26.30
| Professional | 26 | $14.79 | $16.98 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $46.77 / $83.18
| Professional | TC | $38.02 | $46.77 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | 26 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $131.83
| Facility | TC | $42.66 | $42.66 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $54.95 / $109.65
| Professional | | $52.48 | $54.95 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $16.98 / $26.30
| Professional | 26 | $14.13 | $16.98 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $50.12 / $83.18
| Professional | TC | $38.02 | $50.12 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,348.96
| Facility | | $1,148.15 | $1,148.15 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $25.12 / $54.95
| Professional | | $8.32 | $25.12 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $107.15 / $162.18
| Facility | | $22.91 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $48.98 / $75.86
| Professional | | $31.62 | $48.98 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $14.45 / $21.38
| Professional | 26 | $9.12 | $14.45 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $51.29
| Professional | TC | $21.88 | $34.67 | $51.29 |