- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $398.11 / $398.11
| Facility | | $218.78 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $91.20 / $91.20
| Facility | 26 | $50.12 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $158.49 / $457.09
| Professional | | $89.13 | $158.49 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $117.49 / $446.68
| Professional | 26 | $30.20 | $117.49 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $61.66 / $371.54
| Professional | TC | $58.88 | $61.66 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $123.03
| Facility | | $109.65 | $109.65 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $173.78 / $208.93
| Professional | | $120.23 | $173.78 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $28.18 / $51.29
| Professional | 26 | $26.30 | $28.18 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $102.33 / $134.90
| Professional | TC | $95.50 | $102.33 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $177.83 / $302.00
| Professional | | $66.07 | $177.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $53.70 / $64.57
| Professional | 26 | $19.50 | $53.70 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $120.23 / $234.42
| Professional | TC | $43.65 | $120.23 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $181.97 / $269.15
| Professional | | $56.23 | $181.97 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $41.69 / $64.57
| Professional | 26 | $19.50 | $41.69 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $141.25 / $208.93
| Professional | TC | $36.31 | $141.25 | $208.93 |