- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $316.23 / $537.03
| Facility | | $128.82 | $316.23 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $9.12 / $15.85
| Facility | 26 | $8.91 | $9.12 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $131.83 / $549.54
| Facility | TC | $33.11 | $131.83 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $43.65 / $123.03
| Professional | | $9.55 | $43.65 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $17.78 / $48.98
| Professional | 26 | $8.51 | $17.78 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $19.05 / $83.18 / $162.18
| Professional | 50 | $19.05 | $83.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $47.86 / $128.82
| Professional | TC | $26.92 | $47.86 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $218.78 / $630.96
| Facility | | $117.49 | $218.78 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $7.94 / $7.94
| Facility | 26 | $6.61 | $7.94 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $30.20 / $30.20
| Facility | TC | $25.12 | $30.20 | $30.20 |
- 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
- $14.79 / $22.39 / $32.36
| Professional | 26 | $14.79 | $22.39 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Professional | 52 | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $83.18 / $114.82
| Professional | TC | $52.48 | $83.18 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $154.88 / $371.54
| Facility | | $95.50 | $154.88 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $32.36 / $77.62
| Facility | 26 | $13.80 | $32.36 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $120.23 / $288.40
| Facility | TC | $41.69 | $120.23 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $79.43 / $123.03
| Professional | | $40.74 | $79.43 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $16.60 / $26.92
| Professional | 26 | $10.47 | $16.60 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $61.66 / $97.72
| Professional | TC | $29.51 | $61.66 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $147.91 / $288.40
| Facility | | $117.49 | $147.91 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $31.62 / $61.66
| Facility | 26 | $25.12 | $31.62 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $114.82 / $229.09
| Facility | TC | $93.33 | $114.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $112.20
| Professional | | $61.66 | $61.66 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $23.44
| Professional | 26 | $13.18 | $13.18 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $87.10
| Professional | TC | $48.98 | $48.98 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $158.49 / $346.74
| Facility | | $53.70 | $158.49 | $346.74 |
- 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
- $204.17 / $281.84 / $426.58
| Facility | TC | $204.17 | $281.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $117.49 / $199.53
| Professional | | $39.81 | $117.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $23.44 / $51.29
| Professional | 26 | $11.75 | $23.44 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Professional | 50 | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $50.12 / $204.17
| Professional | TC | $28.18 | $50.12 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $218.78 / $309.03
| Facility | | $16.60 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $112.20 / $295.12
| Professional | | $43.65 | $112.20 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $74.13 / $85.11
| Professional | 26 | $10.72 | $74.13 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $109.65 / $223.87
| Professional | TC | $31.62 | $109.65 | $223.87 |