- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $3,981.07 / $7,762.47
| Facility | | $588.84 | $3,981.07 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $194.98
| Facility | 26 | $125.89 | $125.89 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $478.63 / $1,096.48
| Professional | | $371.54 | $478.63 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $158.49 / $407.38
| Professional | 26 | $117.49 | $158.49 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $275.42 / $467.74
| Professional | TC | $223.87 | $275.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $549.54 / $776.25
| Professional | | $389.05 | $549.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $169.82 / $239.88
| Professional | 26 | $123.03 | $169.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $380.19 / $537.03
| Professional | TC | $263.03 | $380.19 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $562.34 / $758.58
| Professional | | $380.19 | $562.34 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $186.21 / $257.04
| Professional | 26 | $151.36 | $186.21 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $354.81 / $512.86
| Professional | TC | $223.87 | $354.81 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $524.81 / $870.96
| Professional | | $512.86 | $524.81 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $181.97 / $316.23
| Professional | 26 | $177.83 | $181.97 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $346.74 / $549.54
| Professional | TC | $338.84 | $346.74 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $371.54 / $389.05
| Professional | | $363.08 | $371.54 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $125.89 / $125.89
| Professional | 26 | $120.23 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $263.03
| Professional | TC | $239.88 | $239.88 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,238.72 / $3,890.45
| Facility | | $1,174.90 | $2,238.72 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $524.81 / $794.33
| Professional | | $407.38 | $524.81 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $204.17 / $323.59
| Professional | 26 | $147.91 | $204.17 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $338.84 / $501.19
| Professional | TC | $239.88 | $338.84 | $501.19 |