- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $3,801.89 / $6,606.93
| Facility | | $125.89 | $3,801.89 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $93.33 / $323.59
| Facility | 26 | $38.90 | $93.33 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $177.83 / $426.58
| Professional | | $112.20 | $177.83 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $81.28 / $199.53
| Professional | 26 | $48.98 | $81.28 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | 52 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $93.33 / $281.84
| Professional | TC | $56.23 | $93.33 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $380.19 / $6,165.95
| Facility | | $87.10 | $380.19 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $512.86 / $512.86
| Facility | 26 | $186.21 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $316.23 / $3,235.94
| Professional | | $138.04 | $316.23 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $107.15 / $549.54
| Professional | 26 | $60.26 | $107.15 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $158.49 / $2,884.03
| Professional | TC | $72.44 | $158.49 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,019.95 / $3,801.89 / $5,495.41
| Facility | | $3,019.95 | $3,801.89 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $154.88 / $208.93
| Professional | 26 | $91.20 | $154.88 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $147.91 / $147.91
| Professional | TC | $85.11 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $5,754.40 / $13,489.63
| Facility | | $741.31 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $288.40 / $630.96
| Professional | | $120.23 | $288.40 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $109.65 / $234.42
| Professional | 26 | $60.26 | $109.65 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $162.18 / $537.03
| Professional | TC | $58.88 | $162.18 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $125.89 / $338.84
| Facility | | $83.18 | $125.89 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $275.42
| Professional | | $87.10 | $128.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $251.19 / $501.19
| Professional | | $162.18 | $251.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $117.49 / $218.78
| Professional | 26 | $83.18 | $117.49 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $208.93
| Professional | TC | $75.86 | $112.20 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $1,737.80 / $2,884.03
| Facility | | $181.97 | $1,737.80 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $213.80 / $218.78
| Professional | | $165.96 | $213.80 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $380.19 / $6,165.95
| Facility | | $87.10 | $380.19 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $512.86 / $512.86
| Facility | 26 | $186.21 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $316.23 / $3,235.94
| Professional | | $138.04 | $316.23 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $107.15 / $549.54
| Professional | 26 | $60.26 | $107.15 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $158.49 / $2,884.03
| Professional | TC | $72.44 | $158.49 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $2,754.23 / $10,471.29
| Facility | | $89.13 | $2,754.23 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $269.15 / $645.65
| Professional | | $165.96 | $269.15 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $112.20 / $251.19
| Professional | 26 | $66.07 | $112.20 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $501.19
| Professional | TC | $79.43 | $125.89 | $501.19 |