- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $158.49 / $338.84
| Facility | | $46.77 | $158.49 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $15.85
| Facility | 26 | $12.59 | $12.59 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $245.47
| Facility | TC | $32.36 | $50.12 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $53.70 / $158.49
| Professional | | $33.11 | $53.70 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $17.78 / $53.70
| Professional | 26 | $10.00 | $17.78 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $38.02 / $83.18
| Professional | TC | $23.99 | $38.02 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.11 / $53.70
| Professional | | $28.18 | $33.11 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $11.48 / $20.42
| Professional | 26 | $8.51 | $11.48 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $24.55 / $41.69
| Professional | TC | $21.38 | $24.55 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $70.79 / $123.03
| Facility | | $46.77 | $70.79 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $58.88 / $63.10
| Professional | | $47.86 | $58.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $22.91
| Professional | 26 | $16.98 | $16.98 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $63.10
| Professional | TC | $46.77 | $46.77 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $34.67 / $58.88
| Facility | | $12.59 | $34.67 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $34.67 / $54.95
| Professional | | $11.75 | $34.67 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Facility | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $91.20
| Professional | | $30.90 | $45.71 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.13 / $27.54
| Professional | 26 | $8.91 | $14.13 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $33.11 / $75.86
| Professional | TC | $22.39 | $33.11 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $165.96 / $371.54
| Facility | | $45.71 | $165.96 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $28.18
| Facility | 26 | $12.59 | $12.59 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $66.07 / $295.12
| Facility | TC | $32.36 | $66.07 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $114.82
| Professional | | $33.88 | $50.12 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $15.14 / $40.74
| Professional | 26 | $10.00 | $15.14 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $34.67 / $77.62
| Professional | TC | $23.44 | $34.67 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Facility | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $41.69 / $63.10
| Professional | | $30.90 | $41.69 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $12.88 / $22.39
| Professional | 26 | $9.12 | $12.88 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $28.84 / $54.95
| Professional | TC | $21.38 | $28.84 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $107.15 / $275.42
| Facility | | $28.18 | $107.15 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $42.66 / $114.82
| Professional | | $33.88 | $42.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $13.18 / $87.10
| Professional | 26 | $10.47 | $13.18 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $29.51 / $141.25
| Professional | TC | $23.99 | $29.51 | $141.25 |