- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $93.33 / $186.21
| Professional | | $75.86 | $93.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $141.25 / $1,023.29
| Professional | 26 | $50.12 | $141.25 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $32.36 / $67.61
| Professional | TC | $28.18 | $32.36 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Professional | 26 | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $100.00 / $128.82
| Professional | | $75.86 | $100.00 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $70.79 / $125.89
| Professional | 26 | $56.23 | $70.79 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.07 / $36.31 / $38.90
| Professional | TC | $4.07 | $36.31 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $47.86 / $109.65
| Professional | | $40.74 | $47.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $31.62 / $95.50
| Professional | 26 | $27.54 | $31.62 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.23 / $16.22 / $41.69
| Professional | TC | $10.23 | $16.22 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $95.50 / $144.54
| Facility | | $75.86 | $95.50 | $144.54 |
- 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
- $53.70 / $85.11 / $199.53
| Professional | | $53.70 | $85.11 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $64.57 / $147.91
| Professional | 26 | $34.67 | $64.57 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $64.57
| Professional | TC | $18.20 | $26.30 | $64.57 |