- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $309.03 / $1,023.29
| Facility | | $66.07 | $309.03 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $22.39 / $50.12
| Facility | 26 | $16.98 | $22.39 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $75.86 / $181.97
| Professional | | $60.26 | $75.86 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $18.20 / $39.81
| Professional | 26 | $15.85 | $18.20 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $52.48 / $134.90
| Professional | TC | $42.66 | $52.48 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $416.87 / $891.25
| Facility | | $21.38 | $416.87 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $95.50 / $186.21
| Professional | | $56.23 | $95.50 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $22.91 / $47.86
| Professional | 26 | $16.22 | $22.91 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $69.18 / $147.91
| Professional | TC | $35.48 | $69.18 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $229.09 / $616.60
| Facility | | $102.33 | $229.09 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.37 / $23.44 / $64.57
| Facility | 26 | $4.37 | $23.44 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $125.89 / $251.19
| Professional | | $64.57 | $125.89 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $26.92 / $54.95
| Professional | 26 | $17.78 | $26.92 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $97.72 / $204.17
| Professional | TC | $45.71 | $97.72 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $426.58 / $831.76
| Facility | | $67.61 | $426.58 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $104.71 / $204.17
| Professional | | $60.26 | $104.71 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $48.98
| Professional | 26 | $15.85 | $22.91 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $79.43 / $158.49
| Professional | TC | $43.65 | $79.43 | $158.49 |