- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $269.15 / $812.83
| Facility | | $72.44 | $269.15 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $20.42 / $21.38
| Facility | 26 | $19.50 | $20.42 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $354.81 / $707.95
| Facility | TC | $54.95 | $354.81 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $37.15 / $74.13
| Professional | | $15.85 | $37.15 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.88 / $36.31
| Professional | 26 | $7.08 | $12.88 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $16.22 / $19.95 / $36.31
| Professional | 52 | $16.22 | $19.95 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $58.88
| Professional | TC | $18.20 | $25.70 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $190.55 / $331.13
| Facility | | $85.11 | $190.55 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $213.80
| Facility | TC | $37.15 | $37.15 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $56.23 / $79.43
| Professional | | $47.86 | $56.23 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $15.14 / $20.42
| Professional | 26 | $12.88 | $15.14 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $41.69 / $57.54
| Professional | TC | $35.48 | $41.69 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $371.54 / $602.56
| Facility | | $147.91 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $67.61
| Professional | | $28.18 | $44.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $12.59 / $17.78
| Professional | 26 | $8.32 | $12.59 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $32.36 / $45.71
| Professional | TC | $19.50 | $32.36 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $107.15
| Professional | | $77.62 | $77.62 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $53.70 / $53.70
| Professional | 26 | $40.74 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $64.57
| Professional | TC | $23.44 | $23.44 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $208.93
| Facility | | $28.84 | $47.86 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $20.42 / $25.70
| Facility | 26 | $19.50 | $20.42 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $213.80 / $707.95
| Facility | TC | $54.95 | $213.80 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $53.70 / $81.28
| Professional | | $26.92 | $53.70 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $15.14 / $22.39
| Professional | 26 | $7.94 | $15.14 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $16.22 / $19.95 / $36.31
| Professional | 52 | $16.22 | $19.95 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $40.74 / $60.26
| Professional | TC | $20.89 | $40.74 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $23.99 / $33.11
| Professional | | $6.31 | $23.99 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $263.03 / $380.19
| Facility | | $213.80 | $263.03 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | TC | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $64.57 / $74.13
| Professional | | $44.67 | $64.57 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $16.60 / $19.50
| Professional | 26 | $12.88 | $16.60 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $47.86 / $54.95
| Professional | TC | $33.11 | $47.86 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $29.51 / $67.61
| Professional | | $28.84 | $29.51 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $7.59 / $17.38
| Professional | 26 | $7.59 | $7.59 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $25.70 / $48.98
| Professional | TC | $21.38 | $25.70 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $30.90 / $57.54
| Professional | | $26.30 | $30.90 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $9.12 / $16.60
| Professional | 26 | $7.94 | $9.12 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $21.88 / $40.74
| Professional | TC | $18.62 | $21.88 | $40.74 |