- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $323.59 / $776.25
| Facility | | $77.62 | $323.59 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $57.54 / $114.82
| Facility | 26 | $37.15 | $57.54 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $87.10 / $309.03
| Professional | | $42.66 | $87.10 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $47.86 / $123.03
| Professional | 26 | $33.11 | $47.86 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $169.82
| Professional | TC | $25.12 | $36.31 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $3,981.07 / $12,022.64
| Facility | | $1,348.96 | $3,981.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $131.83 / $323.59
| Professional | | $61.66 | $131.83 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $70.79 / $134.90
| Professional | 26 | $36.31 | $70.79 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $53.70 / $199.53
| Professional | TC | $25.70 | $53.70 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $190.55 / $478.63
| Facility | | $34.67 | $190.55 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $50.12 / $128.82
| Facility | 26 | $9.33 | $50.12 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $158.49 / $338.84
| Professional | | $70.79 | $158.49 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $79.43 / $147.91
| Professional | 26 | $39.81 | $79.43 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $67.61 / $208.93
| Professional | TC | $29.51 | $67.61 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $977.24 / $3,311.31
| Facility | | $154.88 | $977.24 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $117.49 / $302.00
| Professional | | $61.66 | $117.49 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $64.57 / $123.03
| Professional | 26 | $35.48 | $64.57 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $50.12 / $181.97
| Professional | TC | $26.30 | $50.12 | $181.97 |