- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $4,897.79 / $16,595.87
| Facility | | $912.01 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $346.74
| Facility | 26 | $151.36 | $151.36 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $478.63 / $933.25
| Professional | | $371.54 | $478.63 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $158.49 / $512.86
| Professional | 26 | $123.03 | $158.49 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $562.34
| Professional | TC | $234.42 | $309.03 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $741.31 / $1,288.25
| Facility | | $398.11 | $741.31 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $354.81 / $776.25
| Professional | | $302.00 | $354.81 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $169.82 / $323.59
| Professional | 26 | $123.03 | $169.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $218.78 / $398.11
| Professional | TC | $58.88 | $218.78 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $436.52 / $851.14
| Professional | | $371.54 | $436.52 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $173.78 / $263.03
| Professional | 26 | $138.04 | $173.78 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $269.15 / $537.03
| Professional | TC | $218.78 | $269.15 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $489.78 / $812.83
| Facility | | $346.74 | $489.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $3,090.30 / $7,762.47
| Facility | | $549.54 | $3,090.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $741.31
| Professional | | $302.00 | $426.58 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $162.18 / $269.15
| Professional | 26 | $120.23 | $162.18 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $263.03 / $467.74
| Professional | TC | $194.98 | $263.03 | $467.74 |