- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $218.78 / $575.44
| Professional | | $97.72 | $218.78 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $97.72 / $537.03
| Professional | 26 | $30.90 | $97.72 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $109.65 / $295.12
| Professional | TC | $61.66 | $109.65 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | 26 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $223.87 / $1,071.52
| Professional | | $117.49 | $223.87 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $56.23 / $234.42
| Professional | 26 | $28.18 | $56.23 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $190.55 / $851.14
| Professional | TC | $87.10 | $190.55 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $363.08 / $489.78
| Professional | | $213.80 | $363.08 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $74.13 / $97.72
| Professional | 26 | $43.65 | $74.13 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $295.12 / $389.05
| Professional | TC | $173.78 | $295.12 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $147.91 / $346.74
| Professional | | $91.20 | $147.91 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $36.31 / $79.43
| Professional | 26 | $19.50 | $36.31 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $269.15
| Professional | TC | $74.13 | $120.23 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $190.55 / $309.03
| Facility | | $44.67 | $190.55 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $194.98 / $316.23
| Professional | | $45.71 | $194.98 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $363.08 / $501.19
| Professional | | $190.55 | $363.08 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $75.86 / $102.33
| Professional | 26 | $43.65 | $75.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $288.40 / $389.05
| Professional | TC | $158.49 | $288.40 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Facility | | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $138.04 / $588.84
| Professional | | $67.61 | $138.04 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | 26 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $223.87 / $1,071.52
| Professional | | $117.49 | $223.87 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $56.23 / $234.42
| Professional | 26 | $28.18 | $56.23 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $190.55 / $851.14
| Professional | TC | $87.10 | $190.55 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $79.43 / $524.81
| Facility | | $21.88 | $79.43 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $218.78 / $512.86
| Professional | | $102.33 | $218.78 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $56.23 / $109.65
| Professional | 26 | $28.18 | $56.23 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $177.83 / $416.87
| Professional | TC | $81.28 | $177.83 | $416.87 |