- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $354.81 / $741.31
| Facility | | $83.18 | $354.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $56.23 / $123.03
| Facility | 26 | $36.31 | $56.23 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $89.13 / $275.42
| Professional | | $58.88 | $89.13 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $46.77 / $144.54
| Professional | 26 | $33.11 | $46.77 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $173.78
| Professional | TC | $25.12 | $36.31 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $31.62 / $36.31
| Professional | | $28.18 | $31.62 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $38.02 / $44.67
| Professional | 26 | $34.67 | $38.02 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.47 / $12.88 / $15.14
| Professional | TC | $10.47 | $12.88 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,137.96 / $2,511.89
| Facility | | $1,318.26 | $2,137.96 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $223.87 / $380.19
| Professional | | $89.13 | $223.87 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $85.11 / $138.04
| Professional | 26 | $51.29 | $85.11 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $138.04 / $251.19
| Professional | TC | $38.02 | $138.04 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $44.67 / $81.28
| Facility | | $25.70 | $44.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $46.77 / $83.18
| Professional | | $28.18 | $46.77 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $131.83 / $316.23
| Professional | | $64.57 | $131.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $70.79 / $144.54
| Professional | 26 | $37.15 | $70.79 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $52.48 / $204.17
| Professional | TC | $26.92 | $52.48 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $275.42 / $794.33
| Facility | | $15.49 | $275.42 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $43.65 / $63.10
| Facility | 26 | $9.33 | $43.65 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $114.82 / $302.00
| Professional | | $63.10 | $114.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $61.66 / $128.82
| Professional | 26 | $38.02 | $61.66 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $43.65 / $194.98
| Professional | TC | $25.70 | $43.65 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $43.65
| Professional | | $26.30 | $32.36 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $158.49
| Facility | | $100.00 | $100.00 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $158.49
| Facility | 26 | $100.00 | $100.00 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $81.28 / $234.42
| Professional | | $66.07 | $81.28 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $46.77 / $97.72
| Professional | 26 | $38.02 | $46.77 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $34.67 / $144.54
| Professional | TC | $28.18 | $34.67 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $870.96 / $2,951.21
| Facility | | $97.72 | $870.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $97.72 / $269.15
| Professional | | $58.88 | $97.72 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $57.54 / $107.15
| Professional | 26 | $33.88 | $57.54 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $39.81 / $162.18
| Professional | TC | $25.12 | $39.81 | $162.18 |