- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $269.15 / $724.44
| Professional | | $154.88 | $269.15 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $75.86 / $151.36
| Professional | 26 | $44.67 | $75.86 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $323.59
| Professional | TC | $109.65 | $162.18 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $251.19 / $251.19
| Professional | | $74.13 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $91.20
| Facility | 26 | $74.13 | $74.13 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $239.88 / $398.11
| Professional | | $134.90 | $239.88 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $69.18 / $123.03
| Professional | 26 | $38.90 | $69.18 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $177.83 / $269.15
| Professional | TC | $97.72 | $177.83 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $275.42 / $346.74
| Professional | | $269.15 | $275.42 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $91.20
| Facility | 26 | $74.13 | $74.13 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $354.81 / $426.58
| Professional | | $223.87 | $354.81 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $74.13 / $107.15
| Professional | 26 | $48.98 | $74.13 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $177.83 / $257.04
| Professional | TC | $117.49 | $177.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $194.98 / $302.00
| Professional | | $186.21 | $194.98 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $91.20
| Professional | 26 | $54.95 | $56.23 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $134.90 / $213.80
| Professional | TC | $109.65 | $134.90 | $213.80 |