- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $162.18 / $575.44
| Facility | | $125.89 | $162.18 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $30.90 / $66.07
| Facility | 26 | $25.70 | $30.90 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $123.03 / $288.40
| Professional | | $72.44 | $123.03 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $39.81 / $66.07
| Professional | 26 | $22.91 | $39.81 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $87.10 / $218.78
| Professional | TC | $48.98 | $87.10 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $177.83
| Professional | | $75.86 | $107.15 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $30.20 / $44.67
| Professional | 26 | $17.78 | $30.20 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $77.62 / $138.04
| Professional | TC | $46.77 | $77.62 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $478.63 / $575.44
| Facility | | $186.21 | $478.63 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $91.20 / $151.36
| Professional | | $60.26 | $91.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $47.86
| Professional | 26 | $20.42 | $28.18 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $112.20
| Professional | TC | $38.90 | $61.66 | $112.20 |