- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $288.40 / $524.81
| Facility | | $51.29 | $288.40 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $7.59 / $7.59
| Facility | 26 | $7.59 | $7.59 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $295.12 / $316.23
| Facility | TC | $245.47 | $295.12 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $33.11 / $95.50
| Professional | | $14.13 | $33.11 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $28.84
| Professional | 26 | $7.08 | $10.96 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $31.62 / $61.66
| Professional | TC | $21.88 | $31.62 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $125.89 / $125.89
| Professional | | $81.28 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $30.90
| Professional | 26 | $19.95 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $95.50
| Professional | TC | $61.66 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $51.29 / $77.62
| Professional | | $31.62 | $51.29 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $15.85 / $25.12
| Professional | 26 | $8.51 | $15.85 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $34.67 / $53.70
| Professional | TC | $19.95 | $34.67 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $10.47 / $79.43
| Facility | | $5.37 | $10.47 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $51.29 / $91.20
| Professional | | $27.54 | $51.29 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $14.13 / $27.54
| Professional | 26 | $8.51 | $14.13 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $38.02 / $63.10
| Professional | TC | $19.50 | $38.02 | $63.10 |