- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $213.80 / $354.81
| Facility | | $56.23 | $213.80 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $165.96 / $165.96
| Facility | 26 | $91.20 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $117.49 / $436.52
| Professional | | $83.18 | $117.49 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $162.18 / $616.60
| Professional | 26 | $52.48 | $162.18 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $64.57 / $269.15
| Professional | TC | $53.70 | $64.57 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $158.49
| Facility | | $141.25 | $141.25 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $169.82 / $218.78
| Professional | | $120.23 | $169.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $67.61 / $95.50
| Professional | 26 | $46.77 | $67.61 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $77.62 / $104.71
| Professional | TC | $72.44 | $77.62 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Facility | | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $190.55 / $302.00
| Professional | | $83.18 | $190.55 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $95.50 / $117.49
| Professional | 26 | $36.31 | $95.50 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $97.72 / $181.97
| Professional | TC | $44.67 | $97.72 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $162.18 / $239.88
| Professional | | $61.66 | $162.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $75.86 / $114.82
| Professional | 26 | $35.48 | $75.86 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $87.10 / $131.83
| Professional | TC | $26.30 | $87.10 | $131.83 |