- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $77.62
| Facility | TC | $72.44 | $72.44 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $95.50 / $269.15
| Professional | | $74.13 | $95.50 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $128.82 / $676.08
| Professional | 26 | $52.48 | $128.82 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $33.88 / $66.07
| Professional | TC | $23.99 | $33.88 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $67.61 / $97.72
| Facility | 26 | $14.45 | $67.61 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.55 / $44.67 / $63.10
| Facility | TC | $9.55 | $44.67 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $169.82 / $257.04
| Professional | | $63.10 | $169.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $109.65 / $158.49
| Professional | 26 | $48.98 | $109.65 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $53.70 / $83.18
| Professional | TC | $15.85 | $53.70 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $147.91 / $257.04
| Professional | | $104.71 | $147.91 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $97.72 / $229.09
| Professional | 26 | $79.43 | $97.72 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $53.70 / $229.09
| Professional | TC | $25.70 | $53.70 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $457.09
| Facility | | $114.82 | $151.36 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Facility | 26 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | TC | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $177.83 / $645.65
| Professional | | $93.33 | $177.83 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $109.65 / $380.19
| Professional | 26 | $60.26 | $109.65 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $63.10 / $346.74
| Professional | TC | $30.20 | $63.10 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $177.83 / $309.03
| Professional | | $117.49 | $177.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $114.82 / $229.09
| Professional | 26 | $70.79 | $114.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $54.95 / $83.18
| Professional | TC | $46.77 | $54.95 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $186.21 / $186.21
| Professional | | $134.90 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $125.89 / $125.89
| Professional | 26 | $87.10 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $60.26 / $60.26
| Professional | TC | $48.98 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $93.33 / $181.97
| Professional | | $39.81 | $93.33 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Facility | | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $100.00 / $251.19
| Professional | | $93.33 | $100.00 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $95.50 / $190.55
| Professional | 26 | $63.10 | $95.50 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $34.67 / $87.10
| Professional | TC | $31.62 | $34.67 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $199.53 / $234.42
| Professional | | $169.82 | $199.53 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $120.23 / $141.25
| Professional | 26 | $102.33 | $120.23 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $81.28 / $95.50
| Professional | TC | $69.18 | $81.28 | $95.50 |