- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $354.81 / $724.44
| Professional | | $275.42 | $354.81 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $251.19
| Professional | 26 | $42.66 | $64.57 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $36.31 / $75.86
| Professional | 26 | $23.44 | $36.31 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $123.03 / $676.08
| Professional | | $43.65 | $123.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $575.44
| Professional | | $316.23 | $457.09 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Professional | 26 | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $338.84 / $831.76
| Professional | | $190.55 | $338.84 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $46.77 / $144.54
| Professional | 26 | $35.48 | $46.77 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $588.84
| Facility | 26 | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,311.31 / $4,168.69 / $4,168.69
| Professional | | $3,311.31 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Professional | 26 | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $616.60 / $954.99
| Professional | | $275.42 | $616.60 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $95.50 / $181.97
| Professional | 26 | $46.77 | $95.50 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $416.87
| Professional | | $32.36 | $33.11 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $446.68 / $977.24
| Professional | | $75.86 | $446.68 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $363.08 / $1,174.90
| Professional | | $190.55 | $363.08 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $46.77 / $141.25
| Professional | 26 | $35.48 | $46.77 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $346.74 / $812.83
| Professional | | $213.80 | $346.74 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $54.95 / $158.49
| Professional | 26 | $43.65 | $54.95 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $245.47 / $478.63
| Professional | | $154.88 | $245.47 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $37.15 / $72.44
| Professional | 26 | $30.90 | $37.15 | $72.44 |