- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $316.23 / $831.76
| Facility | | $51.29 | $316.23 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $8.91
| Facility | 26 | $8.91 | $8.91 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $316.23 / $831.76
| Facility | TC | $245.47 | $316.23 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $34.67 / $107.15
| Professional | | $8.91 | $34.67 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $10.00 / $33.88
| Professional | 26 | $8.51 | $10.00 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Professional | 50 | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $38.90 / $213.80
| Professional | TC | $23.99 | $38.90 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $138.04
| Professional | | $89.13 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $36.31
| Professional | 26 | $22.91 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $102.33 / $102.33
| Professional | TC | $66.07 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $56.23 / $87.10
| Professional | | $33.88 | $56.23 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $17.78 / $28.18
| Professional | 26 | $10.00 | $17.78 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $37.15 / $60.26
| Professional | TC | $21.88 | $37.15 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $11.48 / $79.43
| Facility | | $6.03 | $11.48 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $56.23 / $100.00
| Professional | | $30.90 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $16.22 / $29.51
| Professional | 26 | $9.77 | $16.22 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $39.81 / $67.61
| Professional | TC | $20.89 | $39.81 | $67.61 |