- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $169.82 / $426.58
| Facility | | $57.54 | $169.82 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.98 / $63.10
| Facility | 26 | $10.00 | $16.98 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $79.43 / $194.98
| Facility | TC | $39.81 | $79.43 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $33.11 / $120.23
| Professional | | $13.49 | $33.11 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $17.38 / $38.90
| Professional | 26 | $7.08 | $17.38 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Professional | 50 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $10.96 / $19.05 / $28.84
| Professional | 52 | $10.96 | $19.05 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $60.26
| Professional | TC | $19.05 | $25.70 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $51.29 / $63.10
| Professional | | $23.99 | $51.29 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $14.13 / $15.85
| Professional | 26 | $8.51 | $14.13 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $26.92 / $44.67
| Professional | TC | $17.38 | $26.92 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $181.97 / $371.54
| Facility | | $144.54 | $181.97 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $57.54 / $60.26
| Professional | | $54.95 | $57.54 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $14.45 / $15.85
| Professional | 26 | $13.49 | $14.45 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $43.65 / $45.71
| Professional | TC | $39.81 | $43.65 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $323.59
| Facility | | $173.78 | $173.78 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | 26 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | TC | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $67.61 / $95.50
| Professional | | $25.12 | $67.61 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $16.98 / $22.39
| Professional | 26 | $9.12 | $16.98 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $50.12 / $74.13
| Professional | TC | $22.91 | $50.12 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $61.66 / $354.81
| Facility | | $30.20 | $61.66 | $354.81 |
- 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
- $109.65 / $109.65 / $446.68
| Facility | TC | $109.65 | $109.65 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $46.77 / $208.93
| Professional | | $29.51 | $46.77 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $14.13 / $67.61
| Professional | 26 | $9.33 | $14.13 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $33.88 / $158.49
| Professional | TC | $21.38 | $33.88 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $67.61 / $109.65
| Professional | | $60.26 | $67.61 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $16.98 / $26.30
| Professional | 26 | $14.79 | $16.98 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $51.29 / $83.18
| Professional | TC | $45.71 | $51.29 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | 26 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $131.83
| Facility | TC | $42.66 | $42.66 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $48.98 / $109.65
| Professional | | $45.71 | $48.98 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $15.85 / $26.30
| Professional | 26 | $12.88 | $15.85 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $83.18
| Professional | TC | $33.11 | $33.11 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $295.12
| Facility | | $257.04 | $257.04 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $25.12 / $54.95
| Professional | | $8.32 | $25.12 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $107.15 / $162.18
| Facility | | $19.05 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $48.98 / $75.86
| Professional | | $30.20 | $48.98 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.45 / $21.38
| Professional | 26 | $8.91 | $14.45 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $35.48 / $54.95
| Professional | TC | $22.39 | $35.48 | $54.95 |