- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $338.84 / $602.56
| Facility | | $72.44 | $338.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $9.33
| Facility | 26 | $7.08 | $7.08 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $89.13 / $218.78
| Facility | TC | $29.51 | $89.13 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $37.15 / $154.88
| Professional | | $17.78 | $37.15 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $44.67
| Professional | 26 | $7.08 | $10.96 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $112.20
| Professional | 50 | $66.07 | $66.07 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $35.48 / $36.31 / $36.31
| Professional | 52 | $35.48 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $47.86
| Professional | TC | $19.05 | $23.99 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $23.44 / $27.54
| Professional | | $21.88 | $23.44 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $6.46 / $12.30
| Professional | 26 | $5.75 | $6.46 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Professional | 50 | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $42.66 / $42.66
| Facility | | $26.92 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $30.20 / $51.29
| Professional | | $28.84 | $30.20 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $7.24 / $12.59
| Professional | 26 | $7.08 | $7.24 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $36.31 / $45.71 / $58.88
| Professional | 50 | $36.31 | $45.71 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $22.91 / $38.02
| Professional | TC | $20.42 | $22.91 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $169.82 / $501.19
| Facility | | $54.95 | $169.82 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $35.48 / $54.95
| Professional | | $25.12 | $35.48 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $9.77 / $13.49
| Professional | 26 | $6.76 | $9.77 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $43.65
| Professional | TC | $18.20 | $25.70 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $38.90 / $51.29
| Professional | | $0.21 | $38.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.07 / $9.55 / $12.88
| Professional | 26 | $0.07 | $9.55 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.14 / $29.51 / $38.90
| Professional | TC | $0.14 | $29.51 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $0.21 / $48.98
| Professional | | $0.21 | $0.21 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.07 / $0.07 / $12.02
| Professional | 26 | $0.07 | $0.07 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.14 / $0.14 / $36.31
| Professional | TC | $0.14 | $0.14 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $32.36 / $33.11
| Professional | | $30.90 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $7.94 / $8.13
| Professional | 26 | $7.41 | $7.94 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $24.55 / $25.12
| Professional | TC | $22.91 | $24.55 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $181.97
| Facility | | $33.11 | $33.11 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $52.48
| Professional | | $21.88 | $32.36 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $8.71 / $14.45
| Professional | 26 | $5.75 | $8.71 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $23.44 / $39.81
| Professional | TC | $14.79 | $23.44 | $39.81 |