- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $467.74 / $741.31
| Facility | | $151.36 | $467.74 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $13.49 / $13.49
| Facility | 26 | $13.49 | $13.49 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $40.74 / $79.43
| Professional | | $25.12 | $40.74 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $19.95 / $61.66
| Professional | 26 | $11.75 | $19.95 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $50.12
| Professional | TC | $19.05 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $151.36 / $151.36
| Professional | | $97.72 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $52.48 / $52.48
| Professional | 26 | $33.88 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $100.00
| Professional | TC | $64.57 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $58.88 / $97.72
| Professional | | $33.11 | $58.88 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $25.70 / $42.66
| Professional | 26 | $14.79 | $25.70 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $33.11 / $53.70
| Professional | TC | $18.20 | $33.11 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $10.47 / $19.50
| Facility | | $9.12 | $10.47 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $72.44 / $120.23
| Professional | | $34.67 | $72.44 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $28.84 / $52.48
| Professional | 26 | $15.14 | $28.84 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $43.65 / $64.57
| Professional | TC | $19.50 | $43.65 | $64.57 |