- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $186.21 / $204.17
| Facility | | $154.88 | $186.21 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $102.33
| Facility | 26 | $83.18 | $83.18 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $181.97 / $323.59
| Professional | | $125.89 | $181.97 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $199.53
| Professional | 26 | $50.12 | $79.43 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $208.93
| Professional | TC | $58.88 | $93.33 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Professional | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $66.07 / $67.61
| Professional | 26 | $64.57 | $66.07 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $190.55 / $190.55
| Facility | | $120.23 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $151.36 / $251.19
| Professional | | $144.54 | $151.36 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $77.62 / $117.49
| Professional | 26 | $56.23 | $77.62 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $72.44 / $186.21
| Professional | TC | $66.07 | $72.44 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $6,025.60 / $17,782.79
| Facility | | $154.88 | $6,025.60 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $245.47 / $616.60
| Professional | | $141.25 | $245.47 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $81.28 / $141.25
| Professional | 26 | $50.12 | $81.28 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $128.82 / $549.54
| Professional | TC | $69.18 | $128.82 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $177.83 / $245.47
| Professional | | $1.07 | $177.83 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.27 / $91.20 / $125.89
| Professional | 26 | $0.27 | $91.20 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.81 / $89.13 / $123.03
| Professional | TC | $0.81 | $89.13 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $1.07 / $223.87
| Professional | | $1.07 | $1.07 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.27 / $0.27 / $117.49
| Professional | 26 | $0.27 | $0.27 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.81 / $0.81 / $102.33
| Professional | TC | $0.81 | $0.81 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $147.91 / $154.88
| Professional | | $141.25 | $147.91 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $79.43 / $83.18
| Professional | 26 | $77.62 | $79.43 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $69.18 / $70.79
| Professional | TC | $64.57 | $69.18 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $6,456.54
| Facility | | $158.49 | $158.49 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $208.93 / $537.03
| Professional | | $128.82 | $208.93 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $83.18 / $131.83
| Professional | 26 | $41.69 | $83.18 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $107.15 / $416.87
| Professional | TC | $66.07 | $107.15 | $416.87 |