- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $398.11 / $645.65
| Professional | | $275.42 | $398.11 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $74.13 / $251.19
| Professional | 26 | $54.95 | $74.13 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $85.11 / $120.23
| Facility | 26 | $18.20 | $85.11 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $891.25 / $1,445.44
| Professional | | $275.42 | $891.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $138.04 / $251.19
| Professional | 26 | $61.66 | $138.04 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $660.69 / $977.24
| Professional | | $398.11 | $660.69 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $123.03 / $263.03
| Professional | 26 | $100.00 | $123.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Facility | 26 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $851.14 / $3,235.94
| Professional | | $363.08 | $851.14 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $154.88 / $660.69
| Professional | 26 | $74.13 | $154.88 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $891.25 / $1,445.44
| Professional | | $562.34 | $891.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $288.40
| Professional | 26 | $89.13 | $141.25 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $1,023.29
| Professional | | $676.08 | $676.08 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $154.88 / $154.88
| Professional | 26 | $107.15 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $446.68 / $912.01
| Professional | | $75.86 | $446.68 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $398.11 / $1,548.82
| Professional | | $363.08 | $398.11 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $79.43 / $218.78
| Professional | 26 | $77.62 | $79.43 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $977.24 / $1,148.15
| Professional | | $831.76 | $977.24 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $151.36 / $177.83
| Professional | 26 | $128.82 | $151.36 | $177.83 |