- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $158.49 / $407.38
| Professional | | $114.82 | $158.49 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $51.29 / $128.82
| Professional | 26 | $38.02 | $51.29 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $107.15 / $263.03
| Professional | TC | $77.62 | $107.15 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $107.15 / $151.36
| Professional | | $45.71 | $107.15 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $43.65 / $51.29
| Professional | 26 | $40.74 | $43.65 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $95.50 / $144.54
| Professional | TC | $74.13 | $95.50 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Facility | 26 | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $194.98 / $316.23
| Professional | | $128.82 | $194.98 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $56.23 / $100.00
| Professional | 26 | $41.69 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $138.04 / $229.09
| Professional | TC | $91.20 | $138.04 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $169.82 / $257.04
| Professional | | $147.91 | $169.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $51.29 / $74.13
| Professional | 26 | $43.65 | $51.29 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $117.49 / $173.78
| Professional | TC | $102.33 | $117.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $177.83 / $302.00
| Professional | | $128.82 | $177.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $51.29 / $91.20
| Professional | 26 | $38.02 | $51.29 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $123.03 / $213.80
| Professional | TC | $87.10 | $123.03 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $181.97 / $213.80
| Professional | | $128.82 | $181.97 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $53.70 / $64.57
| Professional | 26 | $39.81 | $53.70 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $151.36
| Professional | TC | $89.13 | $128.82 | $151.36 |