- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $426.58 / $794.33
| Facility | | $165.96 | $426.58 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $95.50 / $234.42
| Professional | | $52.48 | $95.50 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.75 / $43.65
| Professional | 26 | $7.94 | $11.75 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $69.18 / $190.55
| Professional | TC | $43.65 | $69.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $208.93 / $213.80
| Professional | | $186.21 | $208.93 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $30.20 / $30.20
| Professional | 26 | $26.30 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $181.97 / $181.97
| Professional | TC | $158.49 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $134.90
| Professional | | $109.65 | $109.65 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $18.62
| Professional | 26 | $14.79 | $14.79 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $117.49
| Professional | TC | $93.33 | $93.33 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $53.70 / $89.13
| Facility | | $47.86 | $53.70 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $162.18 / $512.86
| Professional | | $43.65 | $162.18 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $87.10
| Professional | 26 | $24.55 | $28.84 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $141.25 / $436.52
| Professional | TC | $114.82 | $141.25 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $158.49 / $218.78
| Professional | | $79.43 | $158.49 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $23.99 / $32.36
| Professional | 26 | $12.88 | $23.99 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $134.90 / $190.55
| Professional | TC | $66.07 | $134.90 | $190.55 |