- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $537.03 / $1,258.93
| Facility | | $208.93 | $537.03 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $1,122.02
| Facility | 26 | $40.74 | $40.74 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $218.78 / $436.52
| Professional | | $134.90 | $218.78 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $47.86 / $102.33
| Professional | 26 | $38.90 | $47.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $173.78 / $371.54
| Professional | TC | $85.11 | $173.78 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $190.55 / $346.74
| Professional | | $151.36 | $190.55 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $53.70 / $72.44
| Professional | 26 | $35.48 | $53.70 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $131.83 / $245.47
| Professional | TC | $102.33 | $131.83 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $316.23 / $1,148.15
| Facility | | $275.42 | $316.23 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $194.98 / $363.08
| Professional | | $134.90 | $194.98 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $93.33
| Professional | 26 | $39.81 | $56.23 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $162.18 / $275.42
| Professional | TC | $107.15 | $162.18 | $275.42 |