- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $645.65
| Facility | | $234.42 | $234.42 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | TC | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $524.81
| Professional | | $204.17 | $269.15 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $38.90 / $69.18
| Professional | 26 | $30.90 | $38.90 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $229.09 / $446.68
| Professional | TC | $186.21 | $229.09 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $436.52 / $436.52
| Professional | | $346.74 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $67.61 / $67.61
| Professional | 26 | $53.70 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $363.08 / $363.08
| Professional | TC | $295.12 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $575.44
| Professional | | $251.19 | $416.87 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $58.88 / $85.11
| Professional | 26 | $30.90 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $354.81 / $489.78
| Professional | TC | $223.87 | $354.81 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $134.90 / $158.49
| Facility | | $23.99 | $134.90 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $512.86 / $1,023.29
| Professional | | $257.04 | $512.86 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $70.79 / $109.65
| Professional | 26 | $34.67 | $70.79 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $446.68 / $933.25
| Professional | TC | $218.78 | $446.68 | $933.25 |