- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $501.19 / $1,023.29
| Facility | | $173.78 | $501.19 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $29.51 / $60.26
| Facility | 26 | $26.92 | $29.51 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $213.80 / $812.83
| Facility | TC | $144.54 | $213.80 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $134.90 / $602.56
| Professional | | $23.44 | $134.90 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $32.36 / $107.15
| Professional | 26 | $19.95 | $32.36 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $117.49 / $269.15
| Professional | TC | $89.13 | $117.49 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $223.87 / $263.03
| Professional | | $95.50 | $223.87 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $37.15 / $41.69
| Professional | 26 | $17.78 | $37.15 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Professional | TC | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $295.12 / $602.56
| Facility | | $239.88 | $295.12 | $602.56 |
- 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
- $213.80 / $213.80 / $213.80
| Facility | TC | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $234.42 / $331.13
| Professional | | $165.96 | $234.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $56.23
| Professional | 26 | $28.84 | $40.74 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $190.55 / $269.15
| Professional | TC | $138.04 | $190.55 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $407.38 / $512.86
| Facility | | $257.04 | $407.38 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $223.87 / $389.05
| Professional | | $151.36 | $223.87 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $37.15 / $64.57
| Professional | 26 | $22.91 | $37.15 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $190.55 / $331.13
| Professional | TC | $125.89 | $190.55 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $229.09 / $354.81
| Facility | | $120.23 | $229.09 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $39.81 / $288.40
| Facility | 26 | $24.55 | $39.81 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $199.53 / $331.13
| Facility | TC | $120.23 | $199.53 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $229.09 / $331.13
| Professional | | $134.90 | $229.09 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $37.15 / $53.70
| Professional | 26 | $20.89 | $37.15 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $186.21 / $281.84
| Professional | TC | $109.65 | $186.21 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $66.07
| Professional | | $32.36 | $33.11 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $186.21 / $234.42
| Facility | | $38.90 | $186.21 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $194.98
| Professional | | $32.36 | $45.71 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Facility | | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $28.84 / $28.84
| Facility | 26 | $28.18 | $28.84 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Facility | TC | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $245.47 / $346.74
| Professional | | $162.18 | $245.47 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $42.66 / $60.26
| Professional | 26 | $28.18 | $42.66 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $208.93 / $281.84
| Professional | TC | $134.90 | $208.93 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $302.00 / $602.56
| Facility | | $229.09 | $302.00 | $602.56 |
- 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
- $213.80 / $213.80 / $213.80
| Facility | TC | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $234.42 / $323.59
| Professional | | $165.96 | $234.42 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $53.70
| Professional | 26 | $28.84 | $40.74 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $190.55 / $263.03
| Professional | TC | $138.04 | $190.55 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $389.05 / $707.95
| Facility | | $134.90 | $389.05 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $199.53 / $323.59
| Professional | | $123.03 | $199.53 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $69.18
| Professional | 26 | $22.91 | $33.88 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $263.03
| Professional | TC | $104.71 | $165.96 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $263.03
| Professional | | $138.04 | $138.04 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $23.44 / $41.69
| Professional | 26 | $21.88 | $23.44 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $117.49 / $223.87
| Professional | TC | $114.82 | $117.49 | $223.87 |