- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $512.86 / $537.03
| Facility | | $501.19 | $512.86 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Facility | TC | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $28.18 / $60.26
| Professional | | $15.14 | $28.18 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $15.85 / $31.62
| Professional | 26 | $7.08 | $15.85 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $26.92
| Professional | 52 | $16.22 | $16.22 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $30.90 / $52.48
| Professional | TC | $17.78 | $30.90 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $363.08 / $446.68
| Facility | | $147.91 | $363.08 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Facility | 26 | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | TC | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $120.23
| Professional | | $32.36 | $38.90 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $10.96 / $30.90
| Professional | 26 | $9.33 | $10.96 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $26.92
| Professional | TC | $22.91 | $22.91 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $380.19 / $380.19
| Facility | | $218.78 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $37.15 / $89.13
| Professional | | $33.11 | $37.15 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $10.72 / $22.91
| Professional | 26 | $9.77 | $10.72 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $25.70 / $66.07
| Professional | TC | $21.88 | $25.70 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Professional | | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $7.76
| Professional | 26 | $7.76 | $7.76 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Professional | TC | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $97.72
| Professional | | $28.18 | $37.15 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.23 / $19.05
| Professional | 26 | $7.24 | $10.23 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $26.92 / $53.70
| Professional | TC | $20.42 | $26.92 | $53.70 |