- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $363.08 / $1,096.48
| Facility | | $104.71 | $363.08 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $45.71 / $69.18
| Facility | 26 | $29.51 | $45.71 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $147.91 / $588.84
| Professional | | $85.11 | $147.91 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $32.36 / $107.15
| Professional | 26 | $20.42 | $32.36 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $120.23 / $275.42
| Professional | TC | $95.50 | $120.23 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Professional | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $38.90 / $52.48
| Professional | 26 | $17.78 | $38.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | TC | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $316.23 / $645.65
| Facility | | $251.19 | $316.23 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $190.55 / $263.03
| Professional | | $114.82 | $190.55 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $33.88 / $46.77
| Professional | 26 | $20.42 | $33.88 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $158.49 / $213.80
| Professional | TC | $93.33 | $158.49 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $295.12 / $389.05
| Professional | | $128.82 | $295.12 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $46.77 / $64.57
| Professional | 26 | $21.88 | $46.77 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $239.88 / $331.13
| Professional | TC | $109.65 | $239.88 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $208.93 / $602.56
| Facility | | $123.03 | $208.93 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Facility | 26 | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $269.15 / $1,230.27
| Professional | | $151.36 | $269.15 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $239.88
| Professional | 26 | $25.12 | $41.69 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $234.42 / $1,122.02
| Professional | TC | $158.49 | $234.42 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $281.84 / $331.13
| Professional | | $251.19 | $281.84 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $48.98 / $61.66
| Professional | 26 | $44.67 | $48.98 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $234.42 / $269.15
| Professional | TC | $204.17 | $234.42 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $251.19 / $316.23
| Professional | | $186.21 | $251.19 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $44.67 / $54.95
| Professional | 26 | $23.99 | $44.67 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $204.17 / $263.03
| Professional | TC | $162.18 | $204.17 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $302.00 / $346.74
| Professional | | $223.87 | $302.00 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $138.04 / $177.83
| Facility | | $21.88 | $138.04 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $263.03 / $363.08
| Professional | | $154.88 | $263.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $40.74 / $57.54
| Professional | 26 | $25.12 | $40.74 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $229.09 / $309.03
| Professional | TC | $134.90 | $229.09 | $309.03 |