- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $234.42 / $288.40
| Professional | | $112.20 | $234.42 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $61.66 / $104.71
| Professional | 26 | $37.15 | $61.66 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $100.00 / $186.21
| Professional | TC | $72.44 | $100.00 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | 26 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $208.93 / $208.93
| Professional | | $177.83 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $75.86
| Professional | 26 | $64.57 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $138.04 / $138.04
| Professional | TC | $117.49 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $194.98 / $575.44
| Professional | | $169.82 | $194.98 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $69.18 / $199.53
| Professional | 26 | $36.31 | $69.18 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $128.82 / $275.42
| Professional | TC | $107.15 | $128.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $144.54 / $575.44
| Professional | | $141.25 | $144.54 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $52.48 / $199.53
| Professional | 26 | $47.86 | $52.48 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $93.33 / $107.15
| Professional | TC | $91.20 | $93.33 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $177.83 / $467.74
| Professional | | $141.25 | $177.83 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $60.26 / $123.03
| Professional | 26 | $48.98 | $60.26 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $109.65 / $218.78
| Professional | TC | $91.20 | $109.65 | $218.78 |