- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $181.97 / $302.00
| Facility | | $93.33 | $181.97 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Facility | 26 | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $251.19 / $309.03
| Facility | TC | $234.42 | $251.19 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $60.26 / $144.54
| Professional | | $25.70 | $60.26 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $15.14 / $36.31
| Professional | 26 | $7.94 | $15.14 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $31.62 / $89.13
| Professional | TC | $16.98 | $31.62 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $177.83 / $208.93
| Facility | | $93.33 | $177.83 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $50.12 / $91.20
| Professional | | $34.67 | $50.12 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $13.18 / $23.44
| Professional | 26 | $9.33 | $13.18 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $47.86
| Professional | TC | $25.70 | $34.67 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $173.78 / $302.00
| Facility | | $138.04 | $173.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $57.54 / $93.33
| Professional | | $34.67 | $57.54 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $15.85 / $23.44
| Professional | 26 | $10.00 | $15.85 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $43.65 / $69.18
| Professional | TC | $26.92 | $43.65 | $69.18 |
- 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
- $30.20 / $42.66 / $54.95
| Professional | | $30.20 | $42.66 | $54.95 |
- 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
- $20.42 / $31.62 / $39.81
| Professional | TC | $20.42 | $31.62 | $39.81 |