- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $794.33 / $1,230.27
| Facility | | $288.40 | $794.33 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $186.21 / $218.78
| Facility | 26 | $93.33 | $186.21 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $891.25 / $1,258.93
| Facility | TC | $316.23 | $891.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $281.84 / $630.96
| Professional | | $190.55 | $281.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $109.65
| Professional | 26 | $33.88 | $50.12 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $223.87 / $489.78
| Professional | TC | $169.82 | $223.87 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,202.26 / $1,412.54
| Facility | | $1,023.29 | $1,202.26 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $295.12 / $512.86
| Professional | | $204.17 | $295.12 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $45.71 / $77.62
| Professional | 26 | $30.20 | $45.71 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $245.47 / $416.87
| Professional | TC | $173.78 | $245.47 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $707.95 / $1,548.82
| Facility | | $218.78 | $707.95 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $426.58 / $794.33
| Professional | | $245.47 | $426.58 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $52.48 / $112.20
| Professional | 26 | $33.88 | $52.48 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $346.74 / $676.08
| Professional | TC | $199.53 | $346.74 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $407.38 / $501.19
| Professional | | $371.54 | $407.38 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $54.95 / $72.44
| Professional | 26 | $33.88 | $54.95 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $371.54 / $457.09
| Professional | TC | $316.23 | $371.54 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $75.86 / $346.74
| Professional | | $57.54 | $75.86 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $380.19 / $724.44
| Professional | | $234.42 | $380.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $104.71
| Professional | 26 | $32.36 | $51.29 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $316.23 / $602.56
| Professional | TC | $199.53 | $316.23 | $602.56 |