- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $302.00 / $478.63
| Facility | | $173.78 | $302.00 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $14.45 / $17.78
| Facility | 26 | $9.12 | $14.45 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $245.47 / $478.63
| Facility | TC | $36.31 | $245.47 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $43.65 / $173.78
| Professional | | $11.75 | $43.65 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $17.78 / $58.88
| Professional | 26 | $7.94 | $17.78 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $162.18 / $186.21
| Professional | 50 | $42.66 | $162.18 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $40.74 / $83.18
| Professional | TC | $19.95 | $40.74 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $48.98 / $165.96
| Professional | | $31.62 | $48.98 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $12.88 / $45.71
| Professional | 26 | $8.13 | $12.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $46.77 / $75.86 / $251.19
| Professional | 50 | $46.77 | $75.86 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $123.03
| Professional | TC | $22.91 | $36.31 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $37.15 / $52.48
| Facility | | $12.02 | $37.15 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $28.84 / $39.81
| Professional | | $10.72 | $28.84 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $104.71 / $165.96
| Facility | | $89.13 | $104.71 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $25.12 / $40.74
| Facility | 26 | $21.88 | $25.12 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $79.43 / $125.89
| Facility | TC | $67.61 | $79.43 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $89.13 / $134.90
| Professional | | $34.67 | $89.13 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $21.38 / $33.88
| Professional | 26 | $9.55 | $21.38 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $66.07 / $100.00
| Professional | TC | $24.55 | $66.07 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $56.23 / $309.03
| Facility | | $28.84 | $56.23 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $269.15 / $354.81
| Facility | TC | $223.87 | $269.15 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $72.44 / $97.72
| Professional | | $60.26 | $72.44 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $18.62 / $25.12
| Professional | 26 | $15.49 | $18.62 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $89.13 / $107.15 / $147.91
| Professional | 50 | $89.13 | $107.15 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $53.70 / $67.61
| Professional | TC | $44.67 | $53.70 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $67.61 / $346.74
| Facility | | $28.84 | $67.61 | $346.74 |
- 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
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $263.03 / $457.09
| Facility | TC | $114.82 | $263.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $69.18 / $208.93
| Professional | | $31.62 | $69.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $21.38 / $74.13
| Professional | 26 | $9.12 | $21.38 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $43.65 / $177.83
| Professional | TC | $22.39 | $43.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $69.18
| Facility | | $47.86 | $47.86 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $67.61 / $128.82
| Professional | | $40.74 | $67.61 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $19.50 / $31.62
| Professional | 26 | $10.47 | $19.50 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $47.86 / $95.50
| Professional | TC | $31.62 | $47.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $83.18 / $138.04
| Professional | | $43.65 | $83.18 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $363.08 / $363.08
| Facility | | $97.72 | $363.08 | $363.08 |
- 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
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $154.88
| Facility | TC | $100.00 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $147.91 / $208.93
| Professional | | $46.77 | $147.91 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $43.65 / $74.13
| Professional | 26 | $12.02 | $43.65 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $104.71 / $177.83
| Professional | TC | $34.67 | $104.71 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Professional | | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Professional | 26 | $21.88 | $21.88 | $21.88 |
- 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
- $67.61 / $169.82 / $204.17
| Professional | | $67.61 | $169.82 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $24.55 / $47.86
| Professional | 26 | $19.05 | $24.55 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $52.48 / $138.04
| Professional | TC | $47.86 | $52.48 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $104.71 / $302.00
| Facility | | $8.91 | $104.71 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $102.33 / $234.42
| Professional | | $58.88 | $102.33 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $54.95 / $95.50
| Professional | 26 | $16.22 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $95.50 / $165.96
| Professional | TC | $39.81 | $95.50 | $165.96 |