- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $269.15 / $1,202.26
| Facility | | $42.66 | $269.15 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $18.62
| Facility | 26 | $10.00 | $10.00 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $54.95
| Facility | TC | $32.36 | $32.36 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $117.49
| Professional | | $33.88 | $51.29 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.79 / $29.51
| Professional | 26 | $8.91 | $14.79 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $177.83
| Professional | 50 | $26.92 | $26.92 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $17.78
| Professional | 52 | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $32.36 / $70.79
| Professional | TC | $23.99 | $32.36 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $251.19 / $758.58
| Facility | | $141.25 | $251.19 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $9.12 / $9.12
| Facility | 26 | $7.59 | $9.12 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $27.54 / $27.54
| Facility | TC | $22.91 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $102.33 / $147.91
| Professional | | $67.61 | $102.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $26.92 / $38.02
| Professional | 26 | $17.38 | $26.92 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $81.28 / $109.65
| Professional | TC | $50.12 | $81.28 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $154.88 / $371.54
| Facility | | $95.50 | $154.88 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $38.02 / $93.33
| Facility | 26 | $16.22 | $38.02 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $114.82 / $281.84
| Facility | TC | $40.74 | $114.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $79.43 / $128.82
| Professional | | $44.67 | $79.43 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $19.95 / $31.62
| Professional | 26 | $12.88 | $19.95 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $58.88 / $95.50
| Professional | TC | $31.62 | $58.88 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $147.91 / $295.12
| Facility | | $120.23 | $147.91 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $37.15 / $74.13
| Facility | 26 | $30.20 | $37.15 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $112.20 / $218.78
| Facility | TC | $89.13 | $112.20 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $104.71
| Professional | | $63.10 | $63.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $26.30
| Professional | 26 | $15.85 | $15.85 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $77.62
| Professional | TC | $46.77 | $46.77 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $87.10 / $295.12
| Facility | | $42.66 | $87.10 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | TC | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $70.79 / $263.03
| Professional | | $38.02 | $70.79 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $21.88 / $67.61
| Professional | 26 | $11.48 | $21.88 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $45.71 / $194.98
| Professional | TC | $27.54 | $45.71 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $263.03 / $371.54
| Facility | | $19.50 | $263.03 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $85.11 / $302.00
| Professional | | $44.67 | $85.11 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $85.11 / $87.10
| Professional | 26 | $12.88 | $85.11 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $47.86 / $97.72
| Professional | TC | $28.18 | $47.86 | $97.72 |