- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $208.93 / $457.09
| Facility | | $54.95 | $208.93 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $17.38 / $33.11
| Facility | 26 | $11.22 | $17.38 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $72.44 / $316.23
| Facility | TC | $36.31 | $72.44 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $41.69 / $95.50
| Professional | | $11.48 | $41.69 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $13.49 / $38.02
| Professional | 26 | $7.76 | $13.49 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $281.84
| Professional | 50 | $87.10 | $87.10 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $11.22 / $22.39 / $87.10
| Professional | 52 | $11.22 | $22.39 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $35.48 / $64.57
| Professional | TC | $19.95 | $35.48 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $239.88 / $302.00
| Facility | | $28.18 | $239.88 | $302.00 |
- 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
- $6.03 / $28.18 / $39.81
| Facility | TC | $6.03 | $28.18 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $63.10 / $95.50
| Professional | | $31.62 | $63.10 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $15.14 / $22.91
| Professional | 26 | $8.91 | $15.14 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $46.77 / $72.44
| Professional | TC | $23.44 | $46.77 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $75.86 / $91.20
| Professional | | $67.61 | $75.86 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $17.78 / $20.89
| Professional | 26 | $16.22 | $17.78 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $58.88 / $70.79
| Professional | TC | $51.29 | $58.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $54.95 / $295.12
| Facility | | $32.36 | $54.95 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $16.98 / $33.11
| Facility | 26 | $11.22 | $16.98 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $69.18 / $316.23
| Facility | TC | $36.31 | $69.18 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $56.23 / $95.50
| Professional | | $11.75 | $56.23 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $16.60 / $25.70
| Professional | 26 | $9.55 | $16.60 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $87.10 / $281.84
| Professional | 50 | $52.48 | $87.10 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $11.22 / $21.88 / $83.18
| Professional | 52 | $11.22 | $21.88 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $50.12 / $75.86
| Professional | TC | $25.70 | $50.12 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $42.66 / $66.07
| Facility | | $14.79 | $42.66 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $20.89 / $50.12
| Professional | | $15.49 | $20.89 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $87.10
| Facility | | $30.90 | $48.98 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $97.72
| Professional | | $51.29 | $67.61 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $16.98 / $23.44
| Professional | 26 | $10.96 | $16.98 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $74.13
| Professional | TC | $28.84 | $47.86 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $363.08
| Facility | | $204.17 | $281.84 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 26 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | TC | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $72.44 / $97.72
| Professional | | $57.54 | $72.44 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $17.38 / $22.91
| Professional | 26 | $14.45 | $17.38 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $53.70 / $74.13
| Professional | TC | $40.74 | $53.70 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $323.59 / $426.58
| Facility | | $263.03 | $323.59 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $89.13
| Professional | | $28.18 | $40.74 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.23 / $22.91
| Professional | 26 | $7.94 | $10.23 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $30.90 / $70.79
| Professional | TC | $20.42 | $30.90 | $70.79 |