- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $138.04 / $275.42
| Facility | | $25.70 | $138.04 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.89 / $3.89 / $3.89
| Facility | 26 | $3.89 | $3.89 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.02 / $14.13
| Professional | | $10.00 | $12.02 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $9.33 / $9.77
| Professional | 26 | $3.02 | $9.33 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.08 / $7.94 / $10.00
| Professional | TC | $7.08 | $7.94 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $14.13 / $20.89
| Facility | | $5.01 | $14.13 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $15.14 / $34.67
| Professional | | $5.01 | $15.14 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Facility | | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.05 / $4.90 / $6.92
| Facility | 26 | $1.05 | $4.90 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $21.38 / $77.62
| Professional | | $7.41 | $21.38 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.95 / $6.31 / $26.30
| Professional | 26 | $1.95 | $6.31 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.37 / $15.14 / $60.26
| Professional | TC | $5.37 | $15.14 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $5.75 / $8.32
| Professional | 26 | $5.01 | $5.75 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $15.14 / $26.92
| Professional | | $7.94 | $15.14 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.51 / $3.09 / $7.94
| Professional | 26 | $2.51 | $3.09 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.37 / $12.02 / $19.95
| Professional | TC | $5.37 | $12.02 | $19.95 |