- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $323.59 / $912.01
| Facility | | $97.72 | $323.59 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $26.30
| Facility | 26 | $21.88 | $21.88 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $87.10
| Facility | TC | $74.13 | $74.13 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $263.03 / $707.95
| Professional | | $70.79 | $263.03 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $107.15 / $354.81
| Professional | 26 | $25.12 | $107.15 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $81.28 / $281.84
| Professional | TC | $53.70 | $81.28 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $63.10 / $128.82
| Professional | | $34.67 | $63.10 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $15.14 / $37.15
| Professional | 26 | $12.59 | $15.14 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $45.71 / $91.20
| Professional | TC | $21.88 | $45.71 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $97.72
| Professional | | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Professional | 26 | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $85.11 / $239.88
| Professional | | $56.23 | $85.11 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $26.92 / $61.66
| Professional | 26 | $16.98 | $26.92 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $177.83
| Professional | TC | $40.74 | $63.10 | $177.83 |