- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $138.04 / $331.13
| Facility | | $32.36 | $138.04 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.91 / $34.67
| Facility | 26 | $7.08 | $8.91 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $138.04 / $323.59
| Facility | TC | $21.88 | $138.04 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $43.65 / $112.20
| Professional | | $23.44 | $43.65 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $12.02 / $38.02
| Professional | 26 | $7.76 | $12.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $27.54 / $57.54
| Professional | TC | $15.85 | $27.54 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $144.54 / $363.08
| Facility | | $26.92 | $144.54 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $21.38 / $70.79
| Facility | 26 | $9.77 | $21.38 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $56.23 / $138.04
| Facility | TC | $25.12 | $56.23 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $194.98
| Professional | | $25.70 | $38.90 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $11.22 / $54.95
| Professional | 26 | $7.76 | $11.22 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $138.04
| Professional | TC | $18.20 | $26.92 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $128.82
| Facility | | $70.79 | $89.13 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $89.13
| Professional | | $38.90 | $57.54 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.98 / $22.91
| Professional | 26 | $10.00 | $16.98 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $162.18 / $239.88
| Facility | | $33.88 | $162.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $43.65 / $81.28
| Professional | | $23.44 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.88 / $25.12
| Professional | 26 | $7.08 | $12.88 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $30.90 / $57.54
| Professional | TC | $16.60 | $30.90 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $30.90 / $67.61
| Facility | | $11.22 | $30.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $29.51 / $53.70
| Professional | | $11.22 | $29.51 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $46.77 / $93.33
| Professional | | $30.20 | $46.77 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.30 / $22.91
| Professional | 26 | $8.91 | $12.30 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $30.20 / $58.88
| Professional | TC | $21.38 | $30.20 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $97.72 / $323.59
| Facility | | $26.30 | $97.72 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $18.20 / $64.57
| Professional | | $12.30 | $18.20 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $144.54 / $363.08
| Facility | | $26.92 | $144.54 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $21.38 / $70.79
| Facility | 26 | $9.77 | $21.38 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $56.23 / $138.04
| Facility | TC | $25.12 | $56.23 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $194.98
| Professional | | $25.70 | $38.90 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $11.22 / $54.95
| Professional | 26 | $7.76 | $11.22 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $138.04
| Professional | TC | $18.20 | $26.92 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $104.71 / $389.05
| Facility | | $22.39 | $104.71 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $54.95
| Professional | | $21.88 | $35.48 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $79.43 / $288.40
| Facility | | $14.45 | $79.43 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $95.50
| Professional | | $28.84 | $40.74 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $12.59 / $30.20
| Professional | 26 | $8.71 | $12.59 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $28.84 / $67.61
| Professional | TC | $19.95 | $28.84 | $67.61 |