- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $446.68 / $812.83
| Facility | | $112.20 | $446.68 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $36.31 / $36.31
| Facility | 26 | $25.70 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $112.20 / $199.53
| Professional | | $72.44 | $112.20 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $33.88 / $63.10
| Professional | 26 | $21.38 | $33.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $85.11 / $134.90
| Professional | TC | $51.29 | $85.11 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $91.20 / $181.97
| Professional | | $87.10 | $91.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $20.42 / $28.84
| Professional | 26 | $19.50 | $20.42 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $295.12 / $398.11
| Facility | | $245.47 | $295.12 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $128.82
| Professional | | $75.86 | $107.15 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $27.54 / $32.36
| Professional | 26 | $19.05 | $27.54 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $95.50
| Professional | TC | $56.23 | $81.28 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $91.20 / $97.72
| Facility | | $87.10 | $91.20 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $112.20 / $190.55
| Professional | | $83.18 | $112.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $35.48 / $48.98
| Professional | 26 | $25.12 | $35.48 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $144.54
| Professional | TC | $52.48 | $79.43 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $87.10 / $120.23
| Professional | | $56.23 | $87.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $25.12 / $33.88
| Professional | 26 | $20.42 | $25.12 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $61.66 / $87.10
| Professional | TC | $35.48 | $61.66 | $87.10 |