- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $223.87 / $478.63
| Facility | | $48.98 | $223.87 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $9.77 / $14.45
| Facility | 26 | $7.41 | $9.77 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $208.93 / $660.69
| Facility | TC | $25.12 | $208.93 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $30.20 / $81.28
| Professional | | $8.51 | $30.20 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $14.13 / $46.77
| Professional | 26 | $7.08 | $14.13 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $17.78 / $64.57 / $257.04
| Professional | 50 | $17.78 | $64.57 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $64.57
| Professional | TC | $19.05 | $30.20 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $23.99 / $41.69
| Professional | | $19.95 | $23.99 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $9.12 / $11.75
| Professional | 26 | $6.03 | $9.12 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | 50 | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $23.44 / $33.88
| Professional | TC | $21.38 | $23.44 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $213.80 / $223.87
| Facility | | $190.55 | $213.80 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $33.88 / $54.95
| Professional | | $25.70 | $33.88 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $11.48 / $19.05
| Professional | 26 | $8.71 | $11.48 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.90 / $51.29 / $83.18
| Professional | 50 | $38.90 | $51.29 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $22.39 / $36.31
| Professional | TC | $16.98 | $22.39 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $38.02 / $58.88
| Professional | | $33.88 | $38.02 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $9.77 / $15.14
| Professional | 26 | $8.51 | $9.77 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $28.18 / $43.65
| Professional | TC | $25.12 | $28.18 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $28.18 / $46.77
| Facility | | $8.71 | $28.18 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $27.54 / $45.71
| Professional | | $7.94 | $27.54 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $95.50 / $223.87
| Facility | | $50.12 | $95.50 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $36.31 / $69.18
| Professional | | $24.55 | $36.31 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.47 / $18.20
| Professional | 26 | $6.92 | $10.47 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Professional | 50 | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $26.30 / $52.48
| Professional | TC | $17.78 | $26.30 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $218.78 / $354.81
| Facility | | $93.33 | $218.78 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.86 / $8.71 / $12.59
| Facility | 26 | $1.86 | $8.71 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.62 / $33.88 / $346.74
| Facility | TC | $5.62 | $33.88 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $58.88
| Professional | | $21.88 | $34.67 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $11.48 / $23.99
| Professional | 26 | $6.92 | $11.48 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $43.65
| Professional | TC | $17.78 | $25.70 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $32.36 / $33.11
| Professional | | $13.49 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Facility | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Facility | 26 | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Facility | TC | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $39.81 / $67.61
| Professional | | $30.90 | $39.81 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.23 / $17.38
| Professional | 26 | $7.94 | $10.23 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $50.12
| Professional | TC | $22.91 | $28.84 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $66.07 / $199.53
| Facility | | $9.77 | $66.07 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $31.62 / $61.66
| Professional | | $22.91 | $31.62 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $9.33 / $20.42
| Professional | 26 | $6.61 | $9.33 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $46.77
| Professional | TC | $15.85 | $22.91 | $46.77 |