- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $758.58 / $1,096.48
| Facility | | $323.59 | $758.58 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Facility | 26 | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $114.82 / $436.52
| Professional | | $89.13 | $114.82 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $120.23 / $660.69
| Professional | 26 | $34.67 | $120.23 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $70.79 / $194.98
| Professional | TC | $57.54 | $70.79 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $19.95 / $53.70
| Professional | 26 | $19.05 | $19.95 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $120.23 / $181.97
| Professional | | $43.65 | $120.23 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $67.61 / $199.53
| Professional | | $53.70 | $67.61 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $75.86
| Professional | 26 | $19.05 | $32.36 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $40.74 / $128.82
| Professional | TC | $29.51 | $40.74 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $194.98 / $346.74
| Professional | | $123.03 | $194.98 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $72.44 / $316.23
| Professional | 26 | $45.71 | $72.44 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $117.49 / $309.03
| Professional | TC | $70.79 | $117.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $288.40
| Professional | | $79.43 | $128.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $53.70 / $141.25
| Professional | 26 | $26.92 | $53.70 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $83.18 / $181.97
| Professional | TC | $52.48 | $83.18 | $181.97 |