- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $1,230.27 / $1,621.81
| Facility | | $245.47 | $1,230.27 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $34.67 / $58.88
| Facility | 26 | $30.90 | $34.67 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $177.83 / $758.58
| Facility | TC | $154.88 | $177.83 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $234.42 / $831.76
| Professional | | $169.82 | $234.42 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $141.25
| Professional | 26 | $30.20 | $42.66 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $177.83 / $426.58
| Professional | TC | $141.25 | $177.83 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $602.56 / $1,737.80
| Facility | | $323.59 | $602.56 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $26.92 / $26.92
| Facility | 26 | $22.91 | $26.92 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $138.04 / $138.04
| Facility | TC | $114.82 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $467.74 / $660.69
| Professional | | $288.40 | $467.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $81.28 / $114.82
| Professional | 26 | $50.12 | $81.28 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $426.58 / $562.34
| Professional | TC | $257.04 | $426.58 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $707.95 / $1,698.24
| Facility | | $489.78 | $707.95 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $114.82 / $281.84
| Facility | 26 | $52.48 | $114.82 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $588.84 / $1,412.54
| Facility | TC | $234.42 | $588.84 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $501.19 / $812.83
| Professional | | $234.42 | $501.19 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $83.18 / $134.90
| Professional | 26 | $37.15 | $83.18 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $426.58 / $676.08
| Professional | TC | $199.53 | $426.58 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $676.08 / $1,318.26
| Facility | | $537.03 | $676.08 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $112.20 / $223.87
| Facility | 26 | $91.20 | $112.20 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $562.34 / $1,096.48
| Facility | TC | $446.68 | $562.34 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $478.63 / $741.31
| Professional | | $323.59 | $478.63 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $123.03
| Professional | 26 | $54.95 | $79.43 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $398.11 / $616.60
| Professional | TC | $269.15 | $398.11 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $512.86 / $1,318.26
| Facility | | $218.78 | $512.86 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $562.34 / $812.83 / $1,096.48
| Facility | TC | $562.34 | $812.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $478.63 / $1,584.89
| Professional | | $199.53 | $478.63 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $85.11 / $263.03
| Professional | 26 | $38.90 | $85.11 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $323.59 / $1,380.38
| Professional | TC | $162.18 | $323.59 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $602.56 / $851.14
| Facility | | $32.36 | $602.56 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $446.68 / $1,513.56
| Professional | | $100.00 | $446.68 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $100.00 / $269.15
| Professional | 26 | $40.74 | $100.00 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $302.00 / $524.81
| Professional | TC | $162.18 | $302.00 | $524.81 |