- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $812.83
| Facility | | $338.84 | $501.19 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $134.90 / $141.25
| Facility | 26 | $58.88 | $134.90 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $138.04 / $346.74
| Professional | | $102.33 | $138.04 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $23.99 / $52.48
| Professional | 26 | $14.13 | $23.99 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $114.82 / $213.80
| Professional | TC | $91.20 | $114.82 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $851.14
| Facility | | $724.44 | $724.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $213.80 / $398.11
| Professional | | $107.15 | $213.80 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $22.91 / $41.69
| Professional | 26 | $15.14 | $22.91 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $190.55 / $380.19
| Professional | TC | $93.33 | $190.55 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $389.05 / $1,047.13
| Facility | | $117.49 | $389.05 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $245.47 / $467.74
| Professional | | $147.91 | $245.47 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $26.30 / $64.57
| Professional | 26 | $16.60 | $26.30 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $190.55 / $436.52
| Professional | TC | $120.23 | $190.55 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $223.87 / $269.15
| Professional | | $154.88 | $223.87 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $31.62 / $45.71
| Professional | 26 | $18.62 | $31.62 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $186.21 / $257.04
| Professional | TC | $134.90 | $186.21 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $239.88
| Professional | | $234.42 | $234.42 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $223.87 / $416.87
| Professional | | $141.25 | $223.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $33.88 / $66.07
| Professional | 26 | $18.62 | $33.88 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $186.21 / $363.08
| Professional | TC | $117.49 | $186.21 | $363.08 |