- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $295.12 / $676.08
| Facility | | $51.29 | $295.12 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $7.08 / $12.59
| Facility | 26 | $5.62 | $7.08 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $66.07 / $346.74
| Facility | TC | $22.39 | $66.07 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $34.67 / $97.72
| Professional | | $12.59 | $34.67 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.00 / $38.02
| Professional | 26 | $7.08 | $10.00 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $134.90 / $169.82 / $616.60
| Professional | 50 | $134.90 | $169.82 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $52.48
| Professional | TC | $19.05 | $25.12 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $30.90 / $46.77
| Professional | | $23.44 | $30.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $8.71 / $16.60
| Professional | 26 | $6.76 | $8.71 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $51.29 / $60.26 / $70.79
| Professional | 50 | $51.29 | $60.26 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $25.12 / $36.31
| Professional | TC | $18.62 | $25.12 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $190.55 / $331.13
| Facility | | $75.86 | $190.55 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $26.92 / $36.31
| Professional | | $6.76 | $26.92 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $158.49 / $309.03
| Facility | | $34.67 | $158.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $38.02 / $57.54
| Professional | | $30.90 | $38.02 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $81.28 / $81.28
| Facility | | $33.11 | $81.28 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $26.92
| Facility | TC | $24.55 | $24.55 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $26.92 / $26.92
| Professional | 26 | $8.13 | $26.92 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $120.23 / $263.03
| Facility | | $67.61 | $120.23 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.14 / $10.00 / $14.13
| Facility | 26 | $2.14 | $10.00 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.31 / $29.51 / $41.69
| Facility | TC | $6.31 | $29.51 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $36.31 / $67.61
| Professional | | $25.70 | $36.31 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $10.47 / $19.50
| Professional | 26 | $7.41 | $10.47 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $26.30 / $52.48
| Professional | TC | $18.62 | $26.30 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $363.08
| Facility | | $223.87 | $223.87 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $85.11
| Facility | 26 | $70.79 | $70.79 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Facility | TC | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $302.00 / $302.00
| Professional | | $44.67 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $70.79
| Professional | 26 | $54.95 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $229.09 / $229.09
| Professional | TC | $169.82 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $54.95 / $426.58
| Facility | | $29.51 | $54.95 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $7.08 / $11.48
| Facility | 26 | $5.62 | $7.08 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $64.57 / $407.38
| Facility | TC | $20.89 | $64.57 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $38.90 / $83.18
| Professional | | $22.91 | $38.90 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $10.23 / $25.12
| Professional | 26 | $6.31 | $10.23 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $134.90 / $162.18 / $338.84
| Professional | 50 | $134.90 | $162.18 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $29.51 / $58.88
| Professional | TC | $19.05 | $29.51 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $32.36 / $33.11
| Professional | | $7.24 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $812.83 / $812.83
| Facility | | $186.21 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $33.88 / $70.79
| Professional | | $9.12 | $33.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $42.66 / $95.50
| Facility | | $28.84 | $42.66 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.19 / $10.23 / $14.79
| Facility | 26 | $2.19 | $10.23 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.31 / $29.51 / $41.69
| Facility | TC | $6.31 | $29.51 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $36.31 / $75.86
| Professional | | $25.70 | $36.31 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $9.55 / $16.98
| Professional | 26 | $7.24 | $9.55 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $46.77
| Professional | TC | $18.20 | $25.70 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $81.28 / $186.21
| Facility | | $28.84 | $81.28 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $34.67 / $70.79
| Professional | | $28.18 | $34.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $9.55 / $26.92
| Professional | 26 | $7.94 | $9.55 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $24.55 / $42.66
| Professional | TC | $20.42 | $24.55 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $35.48 / $42.66
| Professional | | $33.88 | $35.48 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $8.91 / $10.72
| Professional | 26 | $8.51 | $8.91 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $26.92 / $32.36
| Professional | TC | $25.70 | $26.92 | $32.36 |