- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $5,370.32 / $7,244.36
| Facility | | $5,370.32 | $5,370.32 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $354.81 / $389.05
| Facility | 26 | $288.40 | $354.81 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $416.87
| Professional | | $117.49 | $181.97 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $81.28 / $199.53
| Professional | 26 | $50.12 | $81.28 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $134.90
| Professional | 52 | $125.89 | $125.89 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $87.10 / $269.15
| Professional | TC | $56.23 | $87.10 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Professional | | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $66.07 / $79.43
| Professional | 26 | $61.66 | $66.07 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $204.17 / $380.19
| Facility | | $46.77 | $204.17 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $154.88 / $245.47
| Professional | | $123.03 | $154.88 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $309.03
| Professional | 26 | $64.57 | $75.86 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $72.44 / $295.12
| Professional | TC | $60.26 | $72.44 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $954.99 / $9,120.11
| Facility | | $302.00 | $954.99 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $93.33 / $131.83
| Facility | 26 | $19.95 | $93.33 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $223.87 / $524.81
| Professional | | $125.89 | $223.87 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $173.78
| Professional | 26 | $56.23 | $81.28 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $114.82 / $426.58
| Professional | TC | $57.54 | $114.82 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $676.08
| Facility | | $134.90 | $204.17 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $190.55 / $363.08 / $363.08
| Facility | 26 | $190.55 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $288.40 / $3,090.30
| Professional | | $165.96 | $288.40 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $89.13 / $549.54
| Professional | 26 | $54.95 | $89.13 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $173.78 / $2,818.38
| Professional | TC | $79.43 | $173.78 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $2,691.53 / $3,311.31
| Facility | | $107.15 | $2,691.53 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $208.93 / $389.05
| Professional | | $151.36 | $208.93 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $85.11 / $190.55
| Professional | 26 | $54.95 | $85.11 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $114.82 / $331.13
| Professional | TC | $72.44 | $114.82 | $331.13 |