- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $177.83 / $416.87
| Facility | | $44.67 | $177.83 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $41.69 / $112.20
| Facility | 26 | $28.84 | $41.69 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $83.18 / $213.80
| Professional | | $40.74 | $83.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $43.65 / $144.54
| Professional | 26 | $25.70 | $43.65 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $141.25 / $223.87 / $363.08
| Professional | 50 | $141.25 | $223.87 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $20.89 / $64.57
| Professional | TC | $14.13 | $20.89 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $40.74 / $61.66
| Professional | | $37.15 | $40.74 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Professional | 26 | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $58.88
| Professional | 50 | $53.70 | $53.70 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $288.40 / $302.00
| Facility | | $257.04 | $288.40 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $107.15 / $169.82
| Professional | | $69.18 | $107.15 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $60.26 / $97.72
| Professional | 26 | $42.66 | $60.26 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $102.33 / $162.18 / $257.04
| Professional | 50 | $102.33 | $162.18 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $45.71 / $74.13
| Professional | TC | $26.30 | $45.71 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $37.15 / $72.44
| Facility | | $17.78 | $37.15 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $34.67 / $64.57
| Professional | | $16.60 | $34.67 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $85.11 / $407.38
| Facility | | $56.23 | $85.11 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $89.13 / $154.88
| Professional | | $45.71 | $89.13 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $46.77 / $89.13
| Professional | 26 | $28.18 | $46.77 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $35.48 / $77.62
| Professional | TC | $16.98 | $35.48 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $169.82 / $524.81
| Facility | | $16.98 | $169.82 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $85.11 / $162.18
| Professional | | $45.71 | $85.11 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $46.77 / $89.13
| Professional | 26 | $28.18 | $46.77 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $31.62 / $75.86
| Professional | TC | $16.98 | $31.62 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $33.11
| Professional | | $25.70 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | 26 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $60.26 / $107.15
| Professional | | $48.98 | $60.26 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $38.02 / $69.18
| Professional | 26 | $30.90 | $38.02 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $21.88 / $38.90
| Professional | TC | $17.78 | $21.88 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $79.43 / $251.19
| Facility | | $32.36 | $79.43 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $117.49
| Professional | | $42.66 | $64.57 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $61.66
| Professional | 26 | $25.70 | $38.02 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $25.70 / $58.88
| Professional | TC | $16.98 | $25.70 | $58.88 |