- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $229.09 / $309.03
| Facility | | $123.03 | $229.09 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $64.57 / $64.57
| Facility | 26 | $34.67 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $162.18 / $977.24
| Facility | TC | $89.13 | $162.18 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $194.98 / $851.14
| Professional | | $77.62 | $194.98 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $89.13 / $281.84
| Professional | 26 | $27.54 | $89.13 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $141.25 / $229.09
| Professional | TC | $56.23 | $141.25 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $102.33
| Facility | | $91.20 | $91.20 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $112.20 / $158.49
| Professional | | $77.62 | $112.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $35.48
| Professional | 26 | $17.78 | $25.70 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $64.57 / $87.10
| Professional | TC | $60.26 | $64.57 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Facility | | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $66.07 / $199.53
| Professional | | $54.95 | $66.07 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $37.15 / $48.98
| Professional | 26 | $13.49 | $37.15 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $48.98 / $151.36
| Professional | TC | $39.81 | $48.98 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $112.20 / $158.49
| Professional | | $35.48 | $112.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $28.84 / $43.65
| Professional | 26 | $13.80 | $28.84 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $83.18 / $112.20
| Professional | TC | $21.88 | $83.18 | $112.20 |