- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $165.96 / $537.03
| Professional | | $125.89 | $165.96 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $85.11 / $194.98
| Professional | 26 | $74.13 | $85.11 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $61.66 / $97.72
| Professional | TC | $48.98 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $239.88 / $239.88
| Professional | | $194.98 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $138.04 / $138.04
| Professional | 26 | $112.20 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $102.33 / $102.33
| Professional | TC | $83.18 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $234.42 / $316.23
| Professional | | $186.21 | $234.42 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $131.83 / $177.83
| Professional | 26 | $107.15 | $131.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $100.00 / $141.25
| Professional | TC | $79.43 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $245.47 / $478.63
| Professional | | $186.21 | $245.47 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $147.91 / $263.03
| Professional | 26 | $104.71 | $147.91 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $208.93
| Professional | TC | $75.86 | $107.15 | $208.93 |