- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $501.19 / $1,148.15
| Facility | | $97.72 | $501.19 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $35.48 / $61.66
| Facility | 26 | $33.11 | $35.48 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $97.72 / $389.05
| Facility | TC | $64.57 | $97.72 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $158.49 / $549.54
| Professional | | $91.20 | $158.49 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $131.83
| Professional | 26 | $30.90 | $48.98 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $87.10 / $199.53
| Professional | TC | $60.26 | $87.10 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $123.03
| Professional | | $67.61 | $85.11 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $35.48 / $54.95
| Professional | 26 | $25.70 | $35.48 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $70.79 / $83.18
| Professional | TC | $66.07 | $70.79 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $114.82 / $169.82
| Professional | | $109.65 | $114.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $39.81 / $61.66
| Professional | 26 | $38.02 | $39.81 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $75.86 / $117.49
| Professional | TC | $70.79 | $75.86 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $75.86 / $138.04
| Facility | | $33.88 | $75.86 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $70.79 / $123.03
| Professional | | $34.67 | $70.79 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $165.96 / $251.19
| Facility | | $154.88 | $165.96 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $39.81 / $56.23
| Facility | 26 | $8.51 | $39.81 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $79.43 / $112.20
| Facility | TC | $16.98 | $79.43 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $158.49 / $501.19
| Professional | | $102.33 | $158.49 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $51.29 / $177.83
| Professional | 26 | $30.90 | $51.29 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $112.20 / $338.84
| Professional | TC | $67.61 | $112.20 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $54.95
| Professional | | $32.36 | $33.11 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $79.43 / $204.17
| Facility | | $32.36 | $79.43 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $123.03 / $190.55
| Professional | | $95.50 | $123.03 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $38.90 / $67.61
| Professional | 26 | $31.62 | $38.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $83.18 / $125.89
| Professional | TC | $63.10 | $83.18 | $125.89 |