- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $977.24 / $1,230.27
| Facility | | $338.84 | $977.24 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $75.86 / $91.20
| Facility | 26 | $47.86 | $75.86 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $501.19 / $1,548.82
| Facility | TC | $288.40 | $501.19 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $707.95
| Professional | | $173.78 | $281.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $43.65 / $117.49
| Professional | 26 | $28.18 | $43.65 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $446.68
| Professional | TC | $162.18 | $223.87 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $645.65 / $831.76
| Facility | | $223.87 | $645.65 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $467.74 / $707.95
| Professional | | $275.42 | $467.74 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $67.61 / $104.71
| Professional | 26 | $36.31 | $67.61 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $398.11 / $630.96
| Professional | TC | $245.47 | $398.11 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $512.86 / $630.96
| Professional | | $457.09 | $512.86 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $77.62 / $91.20
| Professional | 26 | $69.18 | $77.62 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $389.05 / $436.52 / $537.03
| Professional | TC | $389.05 | $436.52 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $380.19 / $724.44
| Facility | | $234.42 | $380.19 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $74.13 / $85.11
| Facility | 26 | $46.77 | $74.13 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $512.86 / $1,548.82
| Facility | TC | $323.59 | $512.86 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $478.63 / $660.69
| Professional | | $263.03 | $478.63 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $74.13 / $109.65
| Professional | 26 | $38.02 | $74.13 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $407.38 / $588.84
| Professional | TC | $223.87 | $407.38 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $389.05 / $489.78
| Facility | | $60.26 | $389.05 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $120.23 / $416.87
| Professional | | $44.67 | $120.23 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $363.08 / $645.65
| Facility | | $229.09 | $363.08 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $524.81 / $691.83
| Professional | | $398.11 | $524.81 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $72.44 / $102.33
| Professional | 26 | $46.77 | $72.44 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $446.68 / $588.84
| Professional | TC | $302.00 | $446.68 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $794.33 / $1,000.00
| Facility | | $630.96 | $794.33 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Facility | 26 | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Facility | TC | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $562.34 / $691.83
| Professional | | $457.09 | $562.34 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $83.18 / $107.15
| Professional | 26 | $69.18 | $83.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $389.05 / $478.63 / $588.84
| Professional | TC | $389.05 | $478.63 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $891.25 / $1,174.90
| Facility | | $724.44 | $891.25 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $446.68 / $691.83
| Professional | | $257.04 | $446.68 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $66.07 / $104.71
| Professional | 26 | $36.31 | $66.07 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $389.05 / $588.84
| Professional | TC | $218.78 | $389.05 | $588.84 |