- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $295.12 / $562.34
| Facility | | $57.54 | $295.12 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $17.78 / $66.07
| Facility | 26 | $10.47 | $17.78 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $269.15 / $575.44
| Facility | TC | $50.12 | $269.15 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $38.02 / $128.82
| Professional | | $8.51 | $38.02 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $17.38 / $39.81
| Professional | 26 | $7.76 | $17.38 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $19.50 / $131.83 / $138.04
| Professional | 50 | $19.50 | $131.83 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $45.71 / $120.23
| Professional | TC | $23.99 | $45.71 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $56.23 / $75.86
| Professional | | $23.99 | $56.23 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $15.49 / $20.42
| Professional | 26 | $9.33 | $15.49 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $131.83
| Professional | 50 | $112.20 | $112.20 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $42.66 / $64.57
| Professional | TC | $23.99 | $42.66 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $173.78 / $389.05
| Facility | | $144.54 | $173.78 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $66.07 / $70.79
| Professional | | $61.66 | $66.07 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $15.49 / $16.60
| Professional | 26 | $14.79 | $15.49 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $51.29 / $53.70
| Professional | TC | $45.71 | $51.29 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $323.59
| Facility | | $204.17 | $204.17 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Facility | 26 | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Facility | TC | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $74.13 / $112.20
| Professional | | $28.84 | $74.13 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $18.62 / $23.99
| Professional | 26 | $9.55 | $18.62 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $57.54 / $87.10
| Professional | TC | $25.70 | $57.54 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $263.03 / $436.52
| Facility | | $56.23 | $263.03 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $100.00 / $100.00
| Facility | 26 | $23.99 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $302.00 / $501.19
| Facility | TC | $131.83 | $302.00 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $54.95 / $234.42
| Professional | | $33.88 | $54.95 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $15.49 / $20.89
| Professional | 26 | $10.23 | $15.49 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $38.90 / $181.97
| Professional | TC | $23.99 | $38.90 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $77.62 / $125.89
| Professional | | $70.79 | $77.62 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $18.62 / $28.18
| Professional | 26 | $16.22 | $18.62 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $58.88 / $97.72
| Professional | TC | $53.70 | $58.88 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Facility | 26 | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $154.88
| Facility | TC | $51.29 | $51.29 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $52.48 / $125.89
| Professional | | $50.12 | $52.48 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $16.98 / $28.18
| Professional | 26 | $14.13 | $16.98 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $97.72
| Professional | TC | $36.31 | $36.31 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $30.20 / $64.57
| Professional | | $9.12 | $30.20 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $107.15 / $162.18
| Facility | | $20.42 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $54.95 / $85.11
| Professional | | $33.88 | $54.95 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $15.85 / $22.39
| Professional | 26 | $9.33 | $15.85 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $61.66
| Professional | TC | $25.12 | $41.69 | $61.66 |