- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $295.12 / $524.81
| Facility | | $128.82 | $295.12 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $8.51 / $114.82
| Facility | 26 | $7.94 | $8.51 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $34.67 / $281.84
| Facility | TC | $33.88 | $34.67 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $40.74 / $114.82
| Professional | | $8.71 | $40.74 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $15.49 / $42.66
| Professional | 26 | $7.94 | $15.49 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.78 / $85.11 / $158.49
| Professional | 50 | $17.78 | $85.11 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $47.86 / $93.33
| Professional | TC | $26.92 | $47.86 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $218.78 / $630.96
| Facility | | $114.82 | $218.78 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $7.41 / $7.41
| Facility | 26 | $6.17 | $7.41 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $30.90 / $30.90
| Facility | TC | $26.92 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $102.33 / $147.91
| Professional | | $67.61 | $102.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $20.89 / $30.20
| Professional | 26 | $13.80 | $20.89 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $87.10 / $117.49
| Professional | TC | $53.70 | $87.10 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $154.88 / $371.54
| Facility | | $97.72 | $154.88 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $29.51 / $72.44
| Facility | 26 | $12.59 | $29.51 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $123.03 / $302.00
| Facility | TC | $43.65 | $123.03 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $79.43 / $125.89
| Professional | | $39.81 | $79.43 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $15.49 / $25.12
| Professional | 26 | $9.55 | $15.49 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $64.57 / $102.33
| Professional | TC | $30.20 | $64.57 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $147.91 / $295.12
| Facility | | $120.23 | $147.91 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $56.23
| Facility | 26 | $22.91 | $28.84 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $120.23 / $234.42
| Facility | TC | $95.50 | $120.23 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $112.20
| Professional | | $63.10 | $63.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $12.30 / $21.88
| Professional | 26 | $12.30 | $12.30 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $91.20
| Professional | TC | $51.29 | $51.29 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $154.88 / $309.03
| Facility | | $50.12 | $154.88 | $309.03 |
- 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
- $186.21 / $275.42 / $371.54
| Facility | TC | $186.21 | $275.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $114.82 / $239.88
| Professional | | $37.15 | $114.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $21.88 / $46.77
| Professional | 26 | $11.48 | $21.88 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $51.29 / $208.93
| Professional | TC | $28.18 | $51.29 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $218.78 / $309.03
| Facility | | $15.49 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $93.33 / $295.12
| Professional | | $41.69 | $93.33 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $67.61 / $85.11
| Professional | 26 | $10.00 | $67.61 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $112.20 / $223.87
| Professional | TC | $32.36 | $112.20 | $223.87 |