- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $223.87 / $501.19
| Facility | | $77.62 | $223.87 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $25.12 / $72.44
| Facility | 26 | $14.79 | $25.12 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $208.93 / $602.56
| Facility | TC | $60.26 | $208.93 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $53.70 / $154.88
| Professional | | $14.79 | $53.70 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $15.14 / $43.65
| Professional | 26 | $9.55 | $15.14 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $120.23 / $186.21
| Professional | 50 | $52.48 | $120.23 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $53.70 / $93.33
| Professional | TC | $28.84 | $53.70 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $239.88 / $302.00
| Facility | | $39.81 | $239.88 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.63 / $12.30 / $17.38
| Facility | 26 | $2.63 | $12.30 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.71 / $39.81 / $57.54
| Facility | TC | $8.71 | $39.81 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $87.10 / $131.83
| Professional | | $44.67 | $87.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $19.95 / $30.90
| Professional | 26 | $12.30 | $19.95 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $67.61 / $104.71
| Professional | TC | $33.11 | $67.61 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $109.65 / $128.82
| Professional | | $97.72 | $109.65 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $23.44 / $27.54
| Professional | 26 | $20.42 | $23.44 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $85.11 / $102.33
| Professional | TC | $75.86 | $85.11 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $100.00 / $407.38
| Facility | | $47.86 | $100.00 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $21.88 / $42.66
| Facility | 26 | $14.79 | $21.88 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $208.93 / $616.60
| Facility | TC | $54.95 | $208.93 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $85.11 / $151.36
| Professional | | $22.91 | $85.11 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $21.38 / $33.88
| Professional | 26 | $10.47 | $21.38 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $186.21
| Professional | 50 | $52.48 | $52.48 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $75.86 / $109.65
| Professional | TC | $35.48 | $75.86 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $63.10 / $93.33
| Facility | | $20.89 | $63.10 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $24.55 / $72.44
| Professional | | $14.79 | $24.55 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $67.61 / $128.82
| Facility | | $40.74 | $67.61 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $134.90
| Professional | | $70.79 | $97.72 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $22.39 / $31.62
| Professional | 26 | $14.45 | $22.39 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $74.13 / $107.15
| Professional | TC | $42.66 | $74.13 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $363.08
| Facility | | $204.17 | $281.84 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 26 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | TC | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $100.00 / $138.04
| Professional | | $72.44 | $100.00 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $22.91 / $30.90
| Professional | 26 | $19.50 | $22.91 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $77.62 / $107.15
| Professional | TC | $53.70 | $77.62 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $323.59 / $426.58
| Facility | | $263.03 | $323.59 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $128.82
| Professional | | $41.69 | $57.54 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $15.14 / $30.90
| Professional | 26 | $11.22 | $15.14 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $97.72
| Professional | TC | $30.20 | $44.67 | $97.72 |