- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $549.54 / $1,230.27
| Facility | | $100.00 | $549.54 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $50.12
| Facility | 26 | $22.91 | $28.84 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $186.21 / $616.60
| Facility | TC | $63.10 | $186.21 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $131.83 / $537.03
| Professional | | $81.28 | $131.83 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $39.81 / $134.90
| Professional | 26 | $26.92 | $39.81 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Professional | 52 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $77.62 / $173.78
| Professional | TC | $54.95 | $77.62 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $128.82
| Professional | | $70.79 | $89.13 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $34.67 / $64.57
| Professional | 26 | $26.30 | $34.67 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $69.18
| Professional | TC | $28.84 | $47.86 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $288.40 / $501.19
| Facility | | $123.03 | $288.40 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $81.28 / $107.15
| Professional | | $28.18 | $81.28 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $190.55 / $741.31
| Facility | | $104.71 | $190.55 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $141.25 / $194.98
| Professional | | $95.50 | $141.25 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $102.33
| Facility | | $79.43 | $79.43 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $67.61 / $75.86
| Facility | TC | $66.07 | $67.61 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $36.31 / $36.31
| Professional | 26 | $33.11 | $36.31 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $302.00 / $537.03
| Facility | | $117.49 | $302.00 | $537.03 |
- 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
- $87.10 / $125.89 / $245.47
| Professional | | $87.10 | $125.89 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $74.13
| Professional | 26 | $28.84 | $38.02 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $87.10 / $165.96
| Professional | TC | $58.88 | $87.10 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Facility | 26 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | TC | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $912.01 / $912.01
| Professional | | $380.19 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Professional | 26 | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $616.60 / $616.60
| Professional | TC | $489.78 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $158.49 / $724.44
| Facility | | $91.20 | $158.49 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $28.84 / $50.12
| Facility | 26 | $22.39 | $28.84 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $151.36 / $616.60
| Facility | TC | $60.26 | $151.36 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $134.90 / $302.00
| Professional | | $81.28 | $134.90 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $43.65 / $95.50
| Professional | 26 | $26.30 | $43.65 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Professional | 52 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $169.82
| Professional | TC | $54.95 | $91.20 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $33.11 / $91.20
| Professional | | $29.51 | $33.11 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $107.15 / $275.42
| Professional | | $36.31 | $107.15 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $151.36 / $275.42
| Facility | | $95.50 | $151.36 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $40.74 / $57.54
| Facility | 26 | $8.71 | $40.74 | $57.54 |
- 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
- $87.10 / $120.23 / $251.19
| Professional | | $87.10 | $120.23 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $36.31 / $67.61
| Professional | 26 | $28.84 | $36.31 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $83.18 / $162.18
| Professional | TC | $58.88 | $83.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $109.65 / $251.19
| Facility | | $77.62 | $109.65 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $125.89 / $218.78
| Professional | | $95.50 | $125.89 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $38.90 / $85.11
| Professional | 26 | $30.90 | $38.90 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $91.20 / $147.91
| Professional | TC | $66.07 | $91.20 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $107.15 / $125.89
| Professional | | $102.33 | $107.15 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $34.67 / $41.69
| Professional | 26 | $33.11 | $34.67 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $72.44 / $85.11
| Professional | TC | $69.18 | $72.44 | $85.11 |