- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $512.86 / $562.34
| Facility | | $331.13 | $512.86 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $389.05 / $407.38
| Facility | TC | $67.61 | $389.05 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $58.88 / $154.88
| Professional | | $33.11 | $58.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $50.12 / $70.79 / $70.79
| Professional | 25 | $50.12 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $60.26
| Professional | 26 | $19.05 | $28.84 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | 50 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $26.92 / $41.69 / $87.10
| Professional | 52 | $26.92 | $41.69 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $38.02 / $97.72
| Professional | TC | $15.14 | $38.02 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $33.11 / $48.98
| Professional | | $15.14 | $33.11 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $19.50 / $22.39
| Professional | 26 | $17.78 | $19.50 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $17.38 / $39.81
| Professional | TC | $15.14 | $17.38 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $93.33
| Facility | | $57.54 | $57.54 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Facility | 26 | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Facility | TC | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $72.44 / $123.03
| Professional | | $32.36 | $72.44 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $26.30 / $52.48
| Professional | 26 | $16.98 | $26.30 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $42.66 / $77.62
| Professional | TC | $14.45 | $42.66 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $43.65 / $83.18
| Professional | | $38.90 | $43.65 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $23.44 / $31.62
| Professional | 26 | $20.89 | $23.44 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $20.42 / $43.65
| Professional | TC | $17.78 | $20.42 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $48.98 / $79.43
| Facility | | $16.98 | $48.98 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $58.88 / $102.33
| Professional | | $39.81 | $58.88 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $24.55 / $43.65
| Professional | 26 | $16.98 | $24.55 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $36.31 / $66.07
| Professional | TC | $20.89 | $36.31 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $41.69 / $58.88
| Professional | | $38.02 | $41.69 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $22.39 / $31.62
| Professional | 26 | $20.42 | $22.39 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $19.50 / $27.54
| Professional | TC | $16.98 | $19.50 | $27.54 |