- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $239.88 / $588.84
| Facility | | $34.67 | $239.88 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $7.94
| Facility | 26 | $7.94 | $7.94 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $245.47 / $263.03
| Facility | TC | $229.09 | $245.47 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $33.88 / $79.43
| Professional | | $7.94 | $33.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $14.79 / $40.74
| Professional | 26 | $7.76 | $14.79 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $34.67 / $70.79
| Professional | TC | $23.99 | $34.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $134.90
| Professional | | $87.10 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $32.36
| Professional | 26 | $20.89 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $102.33 / $102.33
| Professional | TC | $67.61 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $56.23 / $87.10
| Professional | | $33.11 | $56.23 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $16.98 / $27.54
| Professional | 26 | $8.91 | $16.98 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $38.90 / $61.66
| Professional | TC | $21.88 | $38.90 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $11.75 / $79.43
| Facility | | $5.75 | $11.75 | $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
- $9.55 / $14.79 / $30.90
| Professional | 26 | $9.55 | $14.79 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $41.69 / $69.18
| Professional | TC | $21.38 | $41.69 | $69.18 |