- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $165.96 / $407.38
| Facility | | $46.77 | $165.96 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $12.02
| Facility | 26 | $10.72 | $10.72 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $89.13 / $275.42
| Facility | TC | $28.84 | $89.13 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $42.66 / $114.82
| Professional | | $11.75 | $42.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $15.49 / $53.70
| Professional | 26 | $8.51 | $15.49 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.88 / $79.43 / $165.96
| Professional | 50 | $33.88 | $79.43 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $38.02 / $91.20
| Professional | TC | $20.89 | $38.02 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $28.18 / $52.48
| Professional | | $22.91 | $28.18 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $9.77 / $16.98
| Professional | 26 | $7.24 | $9.77 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $32.36 / $39.81 / $41.69
| Professional | 50 | $32.36 | $39.81 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $43.65
| Professional | TC | $17.38 | $24.55 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $109.65
| Facility | | $40.74 | $63.10 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $69.18 / $104.71
| Professional | | $51.29 | $69.18 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $19.50
| Professional | 26 | $14.45 | $14.45 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Professional | 50 | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $54.95
| Professional | TC | $40.74 | $40.74 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $30.20 / $51.29
| Facility | | $10.47 | $30.20 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $30.20 / $47.86
| Professional | | $10.00 | $30.20 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $37.15 / $89.13
| Professional | | $26.30 | $37.15 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $11.75 / $22.91
| Professional | 26 | $7.41 | $11.75 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $32.36 / $44.67 / $47.86
| Professional | 50 | $32.36 | $44.67 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $27.54 / $66.07
| Professional | TC | $18.62 | $27.54 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $177.83 / $407.38
| Facility | | $42.66 | $177.83 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $21.88
| Facility | 26 | $10.72 | $10.72 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $93.33 / $275.42
| Facility | TC | $28.84 | $93.33 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $42.66 / $102.33
| Professional | | $19.95 | $42.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $12.88 / $50.12
| Professional | 26 | $8.51 | $12.88 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.88 / $81.28 / $173.78
| Professional | 50 | $33.88 | $81.28 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $31.62 / $74.13
| Professional | TC | $19.05 | $31.62 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $33.88 / $64.57
| Professional | | $25.12 | $33.88 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.96 / $18.20
| Professional | 26 | $7.94 | $10.96 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $44.67 / $47.86
| Professional | 50 | $33.11 | $44.67 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $23.44 / $46.77
| Professional | TC | $17.38 | $23.44 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $81.28 / $229.09
| Facility | | $23.99 | $81.28 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $36.31 / $107.15
| Professional | | $28.84 | $36.31 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $11.22 / $79.43
| Professional | 26 | $8.71 | $11.22 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $25.12 / $120.23
| Professional | TC | $20.42 | $25.12 | $120.23 |