- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $363.08 / $1,445.44
| Facility | | $134.90 | $363.08 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $67.61
| Facility | 26 | $58.88 | $58.88 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $173.78 / $676.08
| Professional | | $79.43 | $173.78 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $173.78 / $446.68
| Professional | 26 | $57.54 | $173.78 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $104.71 / $295.12
| Professional | TC | $40.74 | $104.71 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $100.00 / $199.53
| Professional | | $58.88 | $100.00 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $97.72
| Professional | 26 | $32.36 | $38.90 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $52.48 / $102.33
| Professional | TC | $26.30 | $52.48 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $151.36 / $151.36
| Professional | | $144.54 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Professional | 26 | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $125.89 / $354.81
| Professional | | $83.18 | $125.89 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $70.79 / $165.96
| Professional | 26 | $44.67 | $70.79 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $72.44 / $186.21
| Professional | TC | $44.67 | $72.44 | $186.21 |