- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $616.60
| Facility | | $602.56 | $602.56 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $30.20 / $91.20
| Professional | | $18.62 | $30.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $15.14
| Professional | 26 | $2.00 | $3.02 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $16.60 / $21.88 / $36.31
| Professional | 52 | $16.60 | $21.88 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $50.12
| Professional | TC | $15.85 | $22.91 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $21.38 / $23.99
| Professional | | $2.95 | $21.38 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.04 / $2.63 / $3.24
| Professional | 26 | $2.04 | $2.63 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.59 / $20.89 / $21.38
| Professional | TC | $12.59 | $20.89 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $54.95
| Facility | | $35.48 | $35.48 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.79 / $4.79 / $4.79
| Facility | 26 | $4.79 | $4.79 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $33.88 / $69.18
| Professional | | $18.62 | $33.88 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.63 / $4.68 / $13.18
| Professional | 26 | $2.63 | $4.68 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $28.18 / $57.54
| Professional | TC | $16.60 | $28.18 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $28.84 / $38.02
| Professional | | $25.12 | $28.84 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $3.55 / $4.79
| Professional | 26 | $3.09 | $3.55 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $25.70 / $33.11
| Professional | TC | $21.88 | $25.70 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $20.42 / $35.48
| Facility | | $3.55 | $20.42 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $30.90 / $56.23
| Professional | | $20.42 | $30.90 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.88 / $4.57 / $12.30
| Professional | 26 | $2.88 | $4.57 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $25.12 / $44.67
| Professional | TC | $17.38 | $25.12 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $27.54 / $38.02
| Professional | | $23.99 | $27.54 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $3.31 / $4.68
| Professional | 26 | $3.09 | $3.31 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $24.55 / $33.88
| Professional | TC | $20.89 | $24.55 | $33.88 |