- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $169.82
| Facility | | $165.96 | $165.96 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | TC | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $363.08
| Professional | | $57.54 | $91.20 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $54.95 / $263.03
| Professional | 26 | $15.85 | $54.95 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $154.88
| Professional | TC | $44.67 | $67.61 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $120.23
| Professional | | $54.95 | $91.20 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $24.55 / $33.88
| Professional | 26 | $12.30 | $24.55 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $45.71 / $95.50
| Professional | TC | $39.81 | $45.71 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $141.25
| Facility | | $57.54 | $57.54 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $60.26 / $151.36
| Professional | | $13.80 | $60.26 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $131.83 / $177.83
| Professional | | $79.43 | $131.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $102.33 / $104.71
| Facility | | $50.12 | $102.33 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $79.43 / $81.28
| Facility | TC | $77.62 | $79.43 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $24.55 / $24.55
| Professional | 26 | $23.99 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $63.10 / $186.21
| Professional | | $44.67 | $63.10 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $15.85 / $57.54
| Professional | 26 | $12.59 | $15.85 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $138.04
| Professional | TC | $32.36 | $45.71 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Facility | 26 | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | TC | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $707.95 / $933.25
| Professional | | $125.89 | $707.95 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $204.17 / $204.17
| Professional | 26 | $162.18 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $724.44 / $724.44
| Professional | TC | $549.54 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $107.15 / $181.97
| Facility | | $66.07 | $107.15 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | TC | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $120.23 / $275.42
| Professional | | $66.07 | $120.23 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $39.81 / $186.21
| Professional | 26 | $15.85 | $39.81 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $95.50 / $162.18
| Professional | TC | $52.48 | $95.50 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $33.11 / $93.33
| Professional | | $21.38 | $33.11 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $102.33 / $223.87
| Professional | | $26.92 | $102.33 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $107.15 / $181.97
| Facility | | $66.07 | $107.15 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $70.79 / $208.93
| Professional | | $44.67 | $70.79 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $15.85 / $60.26
| Professional | 26 | $12.59 | $15.85 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $138.04
| Professional | TC | $32.36 | $45.71 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $47.86 / $79.43
| Facility | | $31.62 | $47.86 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $75.86 / $213.80
| Professional | | $56.23 | $75.86 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $19.95 / $61.66
| Professional | 26 | $15.49 | $19.95 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $53.70 / $158.49
| Professional | TC | $40.74 | $53.70 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $56.23 / $109.65
| Professional | | $41.69 | $56.23 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $12.88 / $25.12
| Professional | 26 | $10.96 | $12.88 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $43.65 / $85.11
| Professional | TC | $30.90 | $43.65 | $85.11 |