- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $194.98 / $269.15
| Facility | | $169.82 | $194.98 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | 26 | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $38.02 / $107.15
| Professional | | $23.44 | $38.02 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $16.60 / $52.48
| Professional | 26 | $7.94 | $16.60 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $64.57
| Professional | TC | $15.85 | $23.99 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $138.04 / $194.98
| Facility | | $93.33 | $138.04 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $69.18
| Professional | | $32.36 | $45.71 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $13.18 / $21.88
| Professional | 26 | $9.33 | $13.18 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $31.62 / $43.65
| Professional | TC | $22.91 | $31.62 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $173.78 / $302.00
| Facility | | $125.89 | $173.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $53.70 / $85.11
| Professional | | $30.90 | $53.70 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $15.85 / $23.44
| Professional | 26 | $9.77 | $15.85 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $39.81 / $61.66
| Professional | TC | $23.99 | $39.81 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $39.81 / $51.29
| Professional | | $29.51 | $39.81 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.59 / $16.98
| Professional | 26 | $10.00 | $12.59 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $28.18 / $36.31
| Professional | TC | $19.50 | $28.18 | $36.31 |