- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $707.95 / $1,318.26
| Facility | | $275.42 | $707.95 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $66.07 / $104.71
| Facility | 26 | $47.86 | $66.07 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $239.88 / $588.84
| Professional | | $169.82 | $239.88 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $134.90
| Professional | 26 | $33.88 | $46.77 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $173.78 / $346.74
| Professional | TC | $131.83 | $173.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $181.97 / $407.38
| Professional | | $173.78 | $181.97 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $66.07 / $74.13
| Professional | 26 | $31.62 | $66.07 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | TC | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $645.65 / $1,318.26
| Facility | | $478.63 | $645.65 | $1,318.26 |
- 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
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $354.81 / $501.19
| Professional | | $251.19 | $354.81 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $102.33
| Professional | 26 | $52.48 | $74.13 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $398.11
| Professional | TC | $199.53 | $281.84 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $870.96 / $1,148.15
| Facility | | $478.63 | $870.96 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $346.74 / $588.84
| Professional | | $229.09 | $346.74 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $61.66 / $117.49
| Professional | 26 | $38.02 | $61.66 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $295.12 / $478.63
| Professional | TC | $190.55 | $295.12 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $363.08 / $630.96
| Facility | | $234.42 | $363.08 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $70.79 / $562.34
| Facility | 26 | $36.31 | $70.79 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $354.81 / $501.19
| Professional | | $218.78 | $354.81 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $61.66 / $95.50
| Professional | 26 | $35.48 | $61.66 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $295.12 / $407.38
| Professional | TC | $186.21 | $295.12 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $95.50
| Professional | | $32.36 | $33.11 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $281.84 / $363.08
| Facility | | $61.66 | $281.84 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $91.20 / $288.40
| Professional | | $45.71 | $91.20 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Facility | 26 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $363.08 / $524.81
| Professional | | $245.47 | $363.08 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $75.86 / $109.65
| Professional | 26 | $51.29 | $75.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $302.00 / $407.38
| Professional | TC | $194.98 | $302.00 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $676.08 / $1,318.26
| Facility | | $446.68 | $676.08 | $1,318.26 |
- 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
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $354.81 / $467.74
| Professional | | $251.19 | $354.81 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $95.50
| Professional | 26 | $52.48 | $74.13 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $389.05
| Professional | TC | $199.53 | $281.84 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $891.25 / $1,621.81
| Facility | | $173.78 | $891.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $309.03 / $501.19
| Professional | | $190.55 | $309.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $104.71
| Professional | 26 | $39.81 | $56.23 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $251.19 / $398.11
| Professional | TC | $158.49 | $251.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $407.38
| Professional | | $213.80 | $213.80 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $42.66 / $75.86
| Professional | 26 | $39.81 | $42.66 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $331.13
| Professional | TC | $173.78 | $173.78 | $331.13 |