- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $109.65 / $251.19
| Professional | | $63.10 | $109.65 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $208.93 / $1,047.13
| Professional | 26 | $52.48 | $208.93 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $37.15 / $67.61
| Professional | TC | $23.99 | $37.15 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $53.70 / $117.49
| Professional | 26 | $29.51 | $53.70 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Professional | TC | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $181.97 / $275.42
| Professional | | $138.04 | $181.97 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $109.65 / $173.78
| Professional | 26 | $83.18 | $109.65 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $112.20
| Professional | TC | $47.86 | $72.44 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $102.33 / $138.04
| Professional | | $48.98 | $102.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $61.66 / $89.13
| Professional | 26 | $31.62 | $61.66 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $40.74 / $54.95
| Professional | TC | $16.60 | $40.74 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $234.42 / $707.95
| Facility | | $117.49 | $234.42 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $144.54 / $707.95
| Facility | 26 | $77.62 | $144.54 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $81.28 / $707.95
| Facility | TC | $39.81 | $81.28 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $213.80 / $288.40
| Professional | | $117.49 | $213.80 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $123.03 / $169.82
| Professional | 26 | $77.62 | $123.03 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $77.62 / $123.03
| Professional | TC | $39.81 | $77.62 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $56.23
| Professional | | $32.36 | $33.11 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $120.23 / $199.53
| Facility | | $64.57 | $120.23 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $229.09 / $275.42
| Professional | | $138.04 | $229.09 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $134.90 / $165.96
| Professional | 26 | $81.28 | $134.90 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $93.33 / $112.20
| Professional | TC | $56.23 | $93.33 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $186.21 / $269.15
| Professional | | $138.04 | $186.21 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $112.20 / $173.78
| Professional | 26 | $83.18 | $112.20 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $74.13 / $104.71
| Professional | TC | $47.86 | $74.13 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $47.86 / $97.72
| Facility | | $31.62 | $47.86 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $97.72 / $234.42
| Professional | | $60.26 | $97.72 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $57.54 / $151.36
| Professional | 26 | $36.31 | $57.54 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $34.67 / $81.28
| Professional | TC | $20.89 | $34.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Professional | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Professional | 26 | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Professional | TC | $47.86 | $47.86 | $47.86 |