- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $346.74 / $501.19
| Facility | | $87.10 | $346.74 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $9.33
| Facility | 26 | $9.33 | $9.33 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $346.74 / $831.76
| Facility | TC | $245.47 | $346.74 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $41.69 / $125.89
| Professional | | $8.91 | $41.69 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $39.81
| Professional | 26 | $7.94 | $10.00 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $25.70 / $33.11 / $33.11
| Professional | 50 | $25.70 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $44.67 / $91.20
| Professional | TC | $28.84 | $44.67 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $162.18 / $162.18
| Professional | | $104.71 | $162.18 | $162.18 |
- 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
- $81.28 / $125.89 / $125.89
| Professional | TC | $81.28 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $66.07 / $107.15
| Professional | | $39.81 | $66.07 | $107.15 |
- 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
- $26.92 / $47.86 / $79.43
| Professional | TC | $26.92 | $47.86 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $14.79 / $79.43
| Facility | | $6.03 | $14.79 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $66.07 / $120.23
| Professional | | $37.15 | $66.07 | $120.23 |
- 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
- $26.92 / $50.12 / $87.10
| Professional | TC | $26.92 | $50.12 | $87.10 |