- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $223.87 / $478.63
| Facility | | $54.95 | $223.87 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $10.47 / $194.98
| Facility | 26 | $7.76 | $10.47 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $223.87 / $645.65
| Facility | TC | $28.84 | $223.87 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $37.15 / $100.00
| Professional | | $8.13 | $37.15 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $14.45 / $46.77
| Professional | 26 | $7.59 | $14.45 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $15.49 / $61.66 / $275.42
| Professional | 50 | $15.49 | $61.66 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $3.80 / $3.80 / $3.80
| Professional | 52 | $3.80 | $3.80 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $37.15 / $77.62
| Professional | TC | $21.38 | $37.15 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $28.18 / $43.65
| Professional | | $21.38 | $28.18 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $8.32 / $13.80
| Professional | 26 | $6.17 | $8.32 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.02 / $40.74 / $48.98
| Professional | 50 | $38.02 | $40.74 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $24.55 / $35.48
| Professional | TC | $19.05 | $24.55 | $35.48 |
- 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
- $26.92 / $35.48 / $56.23
| Professional | | $26.92 | $35.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $11.75 / $18.62
| Professional | 26 | $8.71 | $11.75 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $40.74 / $53.70 / $85.11
| Professional | 50 | $40.74 | $53.70 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $23.99 / $38.90
| Professional | TC | $17.78 | $23.99 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $40.74 / $64.57
| Professional | | $36.31 | $40.74 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $10.23 / $15.85
| Professional | 26 | $8.91 | $10.23 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $30.90 / $47.86
| Professional | TC | $26.92 | $30.90 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $30.90 / $50.12
| Facility | | $9.12 | $30.90 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $29.51 / $48.98
| Professional | | $8.32 | $29.51 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $114.82 / $223.87
| Facility | | $67.61 | $114.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $39.81 / $74.13
| Professional | | $26.92 | $39.81 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.96 / $18.62
| Professional | 26 | $7.24 | $10.96 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Professional | 50 | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $30.20 / $56.23
| Professional | TC | $19.50 | $30.20 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $245.47 / $398.11
| Facility | | $104.71 | $245.47 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.95 / $9.12 / $13.18
| Facility | 26 | $1.95 | $9.12 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.13 / $48.98 / $346.74
| Facility | TC | $8.13 | $48.98 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $36.31 / $63.10
| Professional | | $20.42 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $11.75 / $24.55
| Professional | 26 | $7.08 | $11.75 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $11.75 / $64.57 / $70.79
| Professional | 50 | $11.75 | $64.57 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $47.86
| Professional | TC | $19.05 | $28.84 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $32.36 / $33.11
| Professional | | $13.80 | $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
- $33.11 / $42.66 / $63.10
| Professional | | $33.11 | $42.66 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $10.72 / $15.85
| Professional | 26 | $8.71 | $10.72 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $30.90 / $47.86
| Professional | TC | $25.12 | $30.90 | $47.86 |
- 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
- $25.12 / $33.88 / $74.13
| Professional | | $25.12 | $33.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $9.55 / $22.39
| Professional | 26 | $6.76 | $9.55 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $79.43
| Professional | 50 | $70.79 | $70.79 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $25.12 / $57.54
| Professional | TC | $17.78 | $25.12 | $57.54 |