- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $138.04 / $275.42
| Facility | | $17.78 | $138.04 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $11.75
| Facility | 26 | $10.47 | $10.47 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.24 / $7.24 / $8.51
| Facility | TC | $7.24 | $7.24 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $16.98 / $63.10
| Professional | | $10.00 | $16.98 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $30.20 / $79.43
| Professional | 26 | $10.47 | $30.20 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.02 / $8.51 / $23.99
| Professional | TC | $3.02 | $8.51 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $11.75 / $27.54
| Professional | | $7.94 | $11.75 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $7.08 / $16.98
| Professional | 26 | $5.62 | $7.08 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.34 / $4.79 / $10.72
| Professional | TC | $2.34 | $4.79 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $17.78
| Professional | | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $10.47 / $10.47
| Professional | 26 | $10.23 | $10.47 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $17.78 / $48.98
| Professional | | $11.75 | $17.78 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $12.59 / $28.84
| Professional | 26 | $7.76 | $12.59 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.47 / $7.24 / $20.42
| Professional | TC | $4.47 | $7.24 | $20.42 |