- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $2,089.30 / $3,715.35
| Facility | | $467.74 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $186.21
| Facility | 26 | $128.82 | $128.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $478.63 / $1,230.27
| Professional | | $331.13 | $478.63 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $151.36 / $537.03
| Professional | 26 | $117.49 | $151.36 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $275.42 / $588.84
| Professional | TC | $204.17 | $275.42 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,348.96 / $3,801.89
| Facility | | $56.23 | $1,348.96 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $302.00 / $776.25
| Facility | 26 | $275.42 | $302.00 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $549.54 / $1,412.54
| Professional | | $302.00 | $549.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $186.21 / $489.78
| Professional | 26 | $95.50 | $186.21 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $380.19 / $977.24
| Professional | TC | $208.93 | $380.19 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $870.96 / $1,412.54
| Professional | | $371.54 | $870.96 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $281.84 / $457.09
| Professional | 26 | $120.23 | $281.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $588.84 / $954.99
| Professional | TC | $251.19 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $691.83 / $1,288.25
| Professional | | $436.52 | $691.83 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $234.42 / $436.52
| Professional | 26 | $141.25 | $234.42 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $467.74 / $851.14
| Professional | TC | $263.03 | $467.74 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $239.88 / $602.56
| Facility | | $91.20 | $239.88 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $213.80 / $512.86
| Professional | | $89.13 | $213.80 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,511.89 / $7,079.46
| Facility | | $1,288.25 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $645.65 / $1,071.52
| Professional | | $363.08 | $645.65 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $218.78 / $338.84
| Professional | 26 | $128.82 | $218.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $407.38 / $616.60
| Professional | TC | $234.42 | $407.38 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,000.00 / $1,698.24
| Facility | | $707.95 | $1,000.00 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $691.83 / $812.83
| Professional | | $346.74 | $691.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,348.96 / $3,801.89
| Facility | | $56.23 | $1,348.96 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $302.00 / $776.25
| Facility | 26 | $275.42 | $302.00 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $549.54 / $1,412.54
| Professional | | $302.00 | $549.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $186.21 / $489.78
| Professional | 26 | $95.50 | $186.21 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $380.19 / $977.24
| Professional | TC | $208.93 | $380.19 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $2,089.30 / $5,011.87
| Facility | | $213.80 | $2,089.30 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $1,318.26
| Professional | | $398.11 | $588.84 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $208.93 / $380.19
| Professional | 26 | $138.04 | $208.93 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $398.11 / $758.58
| Professional | TC | $251.19 | $398.11 | $758.58 |