- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $229.09 / $416.87
| Facility | | $89.13 | $229.09 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $15.14
| Facility | 26 | $7.94 | $7.94 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $38.02 / $275.42
| Facility | TC | $21.88 | $38.02 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $43.65 / $114.82
| Professional | | $25.12 | $43.65 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.02 / $36.31
| Professional | 26 | $7.94 | $12.02 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $27.54 / $57.54
| Professional | TC | $17.78 | $27.54 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $213.80 / $616.60
| Facility | | $117.49 | $213.80 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $7.41 / $7.41
| Facility | 26 | $6.17 | $7.41 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $19.05
| Facility | TC | $15.85 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $107.15
| Professional | | $52.48 | $75.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $21.88 / $30.90
| Professional | 26 | $15.14 | $21.88 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $77.62
| Professional | TC | $40.74 | $58.88 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $114.82 / $275.42
| Facility | | $70.79 | $114.82 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $30.90 / $75.86
| Facility | 26 | $13.18 | $30.90 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $81.28 / $199.53
| Facility | TC | $28.18 | $81.28 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $57.54 / $93.33
| Professional | | $30.90 | $57.54 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $16.22 / $25.70
| Professional | 26 | $10.23 | $16.22 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $41.69 / $66.07
| Professional | TC | $20.89 | $41.69 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $107.15 / $213.80
| Facility | | $87.10 | $107.15 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $30.20 / $58.88
| Facility | 26 | $23.99 | $30.20 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $77.62 / $154.88
| Facility | TC | $63.10 | $77.62 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $81.28
| Professional | | $45.71 | $45.71 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $22.91
| Professional | 26 | $12.59 | $12.59 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $58.88
| Professional | TC | $33.11 | $33.11 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $141.25 / $281.84
| Facility | | $42.66 | $141.25 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $223.87 / $288.40
| Facility | TC | $147.91 | $223.87 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $77.62 / $181.97
| Professional | | $29.51 | $77.62 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $23.99 / $48.98
| Professional | 26 | $12.59 | $23.99 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $33.88 / $138.04
| Professional | TC | $18.62 | $33.88 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $218.78 / $309.03
| Facility | | $15.85 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $85.11 / $218.78
| Professional | | $31.62 | $85.11 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $70.79 / $85.11
| Professional | 26 | $10.72 | $70.79 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $95.50 / $147.91
| Professional | TC | $21.88 | $95.50 | $147.91 |