- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $436.52 / $1,148.15
| Facility | | $64.57 | $436.52 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $42.66 / $120.23
| Facility | 26 | $26.92 | $42.66 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $93.33 / $363.08
| Professional | | $48.98 | $93.33 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $44.67 / $128.82
| Professional | 26 | $26.30 | $44.67 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $33.88 / $181.97
| Professional | TC | $20.89 | $33.88 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $104.71 / $371.54
| Facility | | $34.67 | $104.71 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $33.88
| Facility | 26 | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $97.72 / $245.47
| Professional | | $53.70 | $97.72 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $39.81 / $79.43
| Professional | 26 | $28.84 | $39.81 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $52.48 / $186.21
| Professional | TC | $26.92 | $52.48 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $239.88 / $831.76
| Facility | | $93.33 | $239.88 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $39.81 / $107.15
| Facility | 26 | $7.41 | $39.81 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $112.20 / $263.03
| Professional | | $48.98 | $112.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $43.65 / $83.18
| Professional | 26 | $25.70 | $43.65 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $54.95 / $208.93
| Professional | TC | $22.91 | $54.95 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $79.43 / $134.90
| Facility | | $28.18 | $79.43 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $95.50 / $269.15
| Professional | | $52.48 | $95.50 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $38.90 / $151.36
| Professional | 26 | $26.92 | $38.90 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $44.67 / $181.97
| Professional | TC | $23.44 | $44.67 | $181.97 |