- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $144.54 / $323.59
| Facility | | $63.10 | $144.54 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $20.42 / $22.39
| Facility | 26 | $11.75 | $20.42 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $281.84 / $549.54
| Facility | TC | $60.26 | $281.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $42.66 / $87.10
| Professional | | $22.91 | $42.66 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.59 / $28.84
| Professional | 26 | $7.08 | $12.59 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $120.23
| Professional | 50 | $87.10 | $87.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $11.22 / $83.18 / $87.10
| Professional | 52 | $11.22 | $83.18 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $28.84 / $60.26
| Professional | TC | $19.95 | $28.84 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $186.21 / $263.03
| Facility | | $64.57 | $186.21 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | 26 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $158.49
| Facility | TC | $39.81 | $39.81 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $61.66 / $85.11
| Professional | | $51.29 | $61.66 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $15.14 / $20.42
| Professional | 26 | $12.88 | $15.14 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $45.71 / $64.57
| Professional | TC | $38.90 | $45.71 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $275.42 / $501.19
| Facility | | $109.65 | $275.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $48.98 / $77.62
| Professional | | $28.84 | $48.98 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $12.88 / $17.78
| Professional | 26 | $8.71 | $12.88 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $36.31 / $52.48
| Professional | TC | $20.89 | $36.31 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $123.03
| Professional | | $87.10 | $87.10 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $56.23 / $56.23
| Professional | 26 | $41.69 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $81.28
| Professional | TC | $30.20 | $30.20 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $117.49
| Facility | | $30.90 | $52.48 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $20.42 / $22.39
| Facility | 26 | $11.75 | $20.42 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $181.97 / $478.63
| Facility | TC | $57.54 | $181.97 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $57.54 / $87.10
| Professional | | $30.90 | $57.54 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $15.85 / $23.44
| Professional | 26 | $8.32 | $15.85 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $120.23
| Professional | 50 | $87.10 | $87.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $11.22 / $81.28 / $87.10
| Professional | 52 | $11.22 | $81.28 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $45.71 / $64.57
| Professional | TC | $23.99 | $45.71 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $25.70 / $33.11
| Professional | | $6.31 | $25.70 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $218.78 / $309.03
| Facility | | $147.91 | $218.78 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | 26 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | TC | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $69.18 / $81.28
| Professional | | $48.98 | $69.18 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $16.60 / $19.50
| Professional | 26 | $12.88 | $16.60 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $53.70 / $61.66
| Professional | TC | $37.15 | $53.70 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $32.36 / $81.28
| Professional | | $31.62 | $32.36 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $17.38
| Professional | 26 | $7.94 | $7.94 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $28.18 / $52.48
| Professional | TC | $23.99 | $28.18 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $33.11 / $63.10
| Professional | | $28.84 | $33.11 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $9.12 / $17.38
| Professional | 26 | $8.32 | $9.12 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $24.55 / $46.77
| Professional | TC | $20.42 | $24.55 | $46.77 |