- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $87.10 / $218.78
| Facility | | $21.88 | $87.10 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $123.03 / $123.03
| Facility | 26 | $42.66 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $42.66 / $165.96
| Professional | | $30.90 | $42.66 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $63.10 / $275.42
| Professional | 26 | $22.91 | $63.10 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.77 / $18.20 / $38.02
| Professional | TC | $9.77 | $18.20 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $14.79
| Professional | 26 | $14.79 | $14.79 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $66.07 / $93.33
| Professional | | $53.70 | $66.07 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $39.81 / $72.44
| Professional | 26 | $29.51 | $39.81 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $24.55 / $40.74
| Professional | TC | $14.13 | $24.55 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Facility | | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $32.36 / $67.61
| Professional | | $18.62 | $32.36 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $20.42 / $45.71
| Professional | 26 | $14.13 | $20.42 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.68 / $11.22 / $26.92
| Professional | TC | $4.68 | $11.22 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $53.70 / $81.28
| Professional | | $40.74 | $53.70 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $28.84 / $43.65
| Professional | 26 | $21.38 | $28.84 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $25.70 / $38.02
| Professional | TC | $18.62 | $25.70 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $60.26 / $89.13
| Professional | | $38.90 | $60.26 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $37.15 / $64.57
| Professional | 26 | $30.20 | $37.15 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.76 / $23.99 / $38.90
| Professional | TC | $7.76 | $23.99 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Professional | | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $31.62 / $45.71
| Professional | 26 | $30.20 | $31.62 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Professional | 26 | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $79.43
| Facility | | $75.86 | $75.86 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $44.67
| Facility | 26 | $42.66 | $42.66 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $48.98 / $114.82
| Professional | | $33.11 | $48.98 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $29.51 / $74.13
| Professional | 26 | $20.89 | $29.51 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $21.88 / $47.86
| Professional | TC | $12.02 | $21.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $83.18 / $165.96
| Professional | | $50.12 | $83.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $21.88 / $53.70
| Professional | | $8.51 | $21.88 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $34.67
| Professional | 26 | $29.51 | $29.51 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.55 / $23.44 / $25.70
| Professional | TC | $9.55 | $23.44 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $52.48 / $87.10
| Professional | | $29.51 | $52.48 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $31.62 / $57.54
| Professional | 26 | $17.38 | $31.62 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $21.88 / $38.90
| Professional | TC | $11.22 | $21.88 | $38.90 |