- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $134.90 / $1,318.26
| Facility | | $91.20 | $134.90 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $23.99 / $38.02
| Facility | 26 | $18.62 | $23.99 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $87.10 / $186.21
| Professional | | $60.26 | $87.10 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $18.20 / $40.74
| Professional | 26 | $15.14 | $18.20 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $53.70 / $147.91
| Professional | TC | $42.66 | $53.70 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $67.61 / $177.83
| Professional | | $53.70 | $67.61 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $18.20 / $33.88
| Professional | 26 | $14.79 | $18.20 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $48.98 / $141.25
| Professional | TC | $39.81 | $48.98 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $67.61
| Facility | | $26.30 | $26.30 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $67.61 / $95.50
| Professional | | $26.30 | $67.61 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $229.09 / $309.03
| Facility | | $102.33 | $229.09 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.37 / $20.42 / $29.51
| Facility | 26 | $4.37 | $20.42 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $131.83 / $316.23
| Professional | | $61.66 | $131.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $26.92 / $67.61
| Professional | 26 | $13.80 | $26.92 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $107.15 / $275.42
| Professional | TC | $41.69 | $107.15 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $66.07 / $199.53
| Facility | | $52.48 | $66.07 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $104.71 / $147.91
| Professional | | $74.13 | $104.71 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $38.02
| Professional | 26 | $18.20 | $26.92 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $77.62 / $109.65
| Professional | TC | $54.95 | $77.62 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $89.13 / $141.25
| Professional | | $56.23 | $89.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $18.62 / $38.90
| Professional | 26 | $14.45 | $18.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $64.57 / $120.23
| Professional | TC | $40.74 | $64.57 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $512.86
| Facility | | $165.96 | $165.96 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $21.38 / $21.38
| Professional | 26 | $20.89 | $21.38 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $50,118.72 / $75,857.76
| Facility | | $194.98 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $95.50 / $234.42
| Professional | | $77.62 | $95.50 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $25.70 / $47.86
| Professional | 26 | $20.89 | $25.70 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $69.18 / $169.82
| Professional | TC | $54.95 | $69.18 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $457.09 / $616.60
| Facility | | $158.49 | $457.09 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $263.03
| Professional | | $60.26 | $100.00 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $26.30 / $93.33
| Professional | 26 | $16.22 | $26.30 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $74.13 / $245.47
| Professional | TC | $45.71 | $74.13 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $257.04
| Facility | | $54.95 | $91.20 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $21.38 / $67.61
| Facility | 26 | $14.79 | $21.38 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $89.13 / $186.21
| Professional | | $54.95 | $89.13 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $21.38 / $51.29
| Professional | 26 | $14.45 | $21.38 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $66.07 / $134.90
| Professional | TC | $39.81 | $66.07 | $134.90 |