- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $912.01 / $1,258.93
| Facility | | $223.87 | $912.01 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $53.70 / $54.95
| Facility | 26 | $47.86 | $53.70 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $1,000.00 / $1,698.24
| Facility | TC | $269.15 | $1,000.00 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $218.78 / $537.03
| Professional | | $173.78 | $218.78 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $144.54
| Professional | 26 | $30.90 | $45.71 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $186.21 / $389.05
| Professional | TC | $141.25 | $186.21 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $562.34 / $851.14
| Facility | | $398.11 | $562.34 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | 26 | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | TC | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $346.74 / $363.08
| Professional | | $288.40 | $346.74 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $61.66 / $66.07
| Professional | 26 | $50.12 | $61.66 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $281.84 / $295.12
| Professional | TC | $234.42 | $281.84 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $776.25 / $1,348.96
| Facility | | $316.23 | $776.25 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $295.12 / $501.19
| Professional | | $213.80 | $295.12 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $51.29 / $91.20
| Professional | 26 | $36.31 | $51.29 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $245.47 / $407.38
| Professional | TC | $162.18 | $245.47 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $724.44
| Professional | | $316.23 | $316.23 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $138.04 / $138.04
| Professional | 26 | $120.23 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $602.56
| Professional | TC | $177.83 | $177.83 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $302.00 / $954.99
| Facility | | $181.97 | $302.00 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $54.95 / $57.54
| Facility | 26 | $48.98 | $54.95 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $741.31 / $1,698.24
| Facility | TC | $234.42 | $741.31 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $316.23 / $489.78
| Professional | | $194.98 | $316.23 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $56.23 / $89.13
| Professional | 26 | $31.62 | $56.23 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $263.03 / $398.11
| Professional | TC | $165.96 | $263.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $33.11 / $120.23
| Professional | | $25.70 | $33.11 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $549.54 / $812.83
| Facility | | $446.68 | $549.54 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | 26 | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | TC | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $281.84 / $380.19
| Professional | | $239.88 | $281.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $47.86 / $61.66
| Professional | 26 | $40.74 | $47.86 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $229.09 / $309.03
| Professional | TC | $194.98 | $229.09 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $190.55 / $630.96
| Professional | | $169.82 | $190.55 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $53.70
| Professional | 26 | $30.20 | $30.20 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $251.19
| Professional | TC | $138.04 | $138.04 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $309.03 / $426.58
| Professional | | $199.53 | $309.03 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $48.98 / $70.79
| Professional | 26 | $35.48 | $48.98 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $257.04 / $371.54
| Professional | TC | $162.18 | $257.04 | $371.54 |