- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $331.13 / $478.63
| Professional | | $302.00 | $331.13 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $37.15 / $54.95
| Professional | 26 | $32.36 | $37.15 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $295.12 / $426.58
| Professional | TC | $263.03 | $295.12 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $363.08 / $389.05
| Professional | | $177.83 | $363.08 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $47.86 / $54.95
| Professional | 26 | $36.31 | $47.86 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $323.59 / $346.74
| Professional | TC | $141.25 | $323.59 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $208.93 / $549.54
| Professional | | $186.21 | $208.93 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $25.12 / $67.61
| Professional | 26 | $22.91 | $25.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $186.21 / $478.63
| Professional | TC | $162.18 | $186.21 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $380.19 / $933.25
| Professional | | $223.87 | $380.19 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $47.86 / $120.23
| Professional | 26 | $27.54 | $47.86 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $323.59 / $812.83
| Professional | TC | $194.98 | $323.59 | $812.83 |