- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $575.44 / $1,096.48
| Professional | | $467.74 | $575.44 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $51.29 / $107.15
| Professional | 26 | $40.74 | $51.29 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $501.19 / $977.24
| Professional | TC | $371.54 | $501.19 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $501.19 / $1,023.29
| Professional | | $288.40 | $501.19 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $47.86 / $95.50
| Professional | 26 | $27.54 | $47.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $457.09 / $912.01
| Professional | TC | $263.03 | $457.09 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,071.52 / $1,548.82
| Professional | | $537.03 | $1,071.52 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $109.65 / $154.88
| Professional | 26 | $53.70 | $109.65 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $977.24 / $1,380.38
| Professional | TC | $489.78 | $977.24 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $977.24 / $1,949.84
| Professional | | $645.65 | $977.24 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $97.72 / $186.21
| Professional | 26 | $52.48 | $97.72 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $891.25 / $1,778.28
| Professional | TC | $512.86 | $891.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $123.03 / $1,174.90
| Professional | | $87.10 | $123.03 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,148.15 / $1,778.28
| Professional | | $478.63 | $1,148.15 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $58.88 / $165.96
| Professional | 26 | $30.20 | $58.88 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $575.44 / $1,479.11
| Professional | TC | $295.12 | $575.44 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,288.25 / $1,862.09
| Professional | | $870.96 | $1,288.25 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $117.49 / $177.83
| Professional | 26 | $81.28 | $117.49 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $794.33 / $1,148.15 / $1,659.59
| Professional | TC | $794.33 | $1,148.15 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $588.84 / $1,862.09
| Professional | | $354.81 | $588.84 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $60.26 / $177.83
| Professional | 26 | $35.48 | $60.26 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $524.81 / $1,698.24
| Professional | TC | $316.23 | $524.81 | $1,698.24 |