- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $134.90 / $398.11
| Professional | | $85.11 | $134.90 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $107.15 / $457.09
| Professional | 26 | $37.15 | $107.15 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $363.08
| Professional | TC | $52.48 | $89.13 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Facility | 26 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $194.98 / $912.01
| Professional | | $107.15 | $194.98 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $89.13 / $363.08
| Professional | 26 | $40.74 | $89.13 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $158.49 / $562.34
| Professional | TC | $75.86 | $158.49 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $144.54 / $407.38
| Professional | | $141.25 | $144.54 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $81.28 / $107.15
| Professional | 26 | $47.86 | $81.28 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | TC | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $117.49 / $288.40
| Professional | | $64.57 | $117.49 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $41.69 / $97.72
| Professional | 26 | $21.88 | $41.69 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $74.13 / $190.55
| Professional | TC | $42.66 | $74.13 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $112.20 / $199.53
| Professional | | $51.29 | $112.20 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $234.42 / $331.13
| Professional | | $125.89 | $234.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $83.18 / $117.49
| Professional | 26 | $48.98 | $83.18 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $154.88 / $213.80
| Professional | TC | $89.13 | $154.88 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Facility | 26 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $194.98 / $912.01
| Professional | | $107.15 | $194.98 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $89.13 / $363.08
| Professional | 26 | $40.74 | $89.13 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $158.49 / $562.34
| Professional | TC | $75.86 | $158.49 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $181.97 / $346.74
| Professional | | $109.65 | $181.97 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $66.07 / $125.89
| Professional | 26 | $39.81 | $66.07 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $114.82 / $223.87
| Professional | TC | $69.18 | $114.82 | $223.87 |