- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $776.25 / $1,202.26
| Facility | | $199.53 | $776.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $38.90 / $63.10
| Facility | 26 | $38.02 | $38.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $204.17 / $426.58
| Professional | | $162.18 | $204.17 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $44.67 / $95.50
| Professional | 26 | $33.88 | $44.67 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $295.12
| Professional | TC | $128.82 | $162.18 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $416.87 / $457.09
| Professional | | $316.23 | $416.87 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $89.13 / $97.72
| Professional | 26 | $66.07 | $89.13 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $331.13 / $363.08
| Professional | TC | $245.47 | $331.13 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $338.84 / $501.19
| Professional | | $186.21 | $338.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $67.61 / $97.72
| Professional | 26 | $38.02 | $67.61 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $275.42 / $398.11
| Professional | TC | $151.36 | $275.42 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $407.38
| Facility | | $190.55 | $288.40 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $363.08 / $1,445.44
| Professional | | $190.55 | $363.08 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $74.13 / $363.08
| Professional | 26 | $40.74 | $74.13 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $288.40 / $1,288.25
| Professional | TC | $151.36 | $288.40 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $316.23 / $467.74
| Professional | | $109.65 | $316.23 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $69.18 / $102.33
| Professional | 26 | $38.02 | $69.18 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $269.15 / $398.11
| Professional | TC | $151.36 | $269.15 | $398.11 |