- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $323.59 / $724.44
| Facility | | $234.42 | $323.59 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $151.36 / $512.86
| Professional | | $109.65 | $151.36 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $67.61 / $389.05
| Professional | 26 | $50.12 | $67.61 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $72.44 / $190.55
| Professional | TC | $57.54 | $72.44 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $436.52 / $446.68
| Professional | | $389.05 | $436.52 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $173.78 / $173.78
| Professional | 26 | $151.36 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $269.15 / $269.15
| Professional | TC | $234.42 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $269.15
| Professional | | $213.80 | $213.80 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $104.71
| Professional | 26 | $83.18 | $83.18 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $162.18
| Professional | TC | $131.83 | $131.83 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $109.65 / $165.96
| Facility | | $91.20 | $109.65 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $323.59 / $1,949.84
| Professional | | $177.83 | $323.59 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $169.82 / $436.52
| Professional | 26 | $147.91 | $169.82 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $181.97 / $562.34
| Professional | TC | $162.18 | $181.97 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $323.59 / $457.09
| Professional | | $162.18 | $323.59 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $138.04 / $177.83
| Professional | 26 | $75.86 | $138.04 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $181.97 / $275.42
| Professional | TC | $85.11 | $181.97 | $275.42 |