- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $295.12 / $1,819.70
| Facility | | $75.86 | $295.12 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $27.54
| Facility | 26 | $23.44 | $23.44 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $69.18
| Facility | TC | $52.48 | $52.48 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $245.47 / $741.31
| Professional | | $60.26 | $245.47 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $229.09 / $954.99
| Professional | 26 | $30.20 | $229.09 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $93.33 / $660.69
| Professional | TC | $28.18 | $93.33 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $56.23 / $91.20
| Professional | | $30.90 | $56.23 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $15.85 / $29.51
| Professional | 26 | $9.77 | $15.85 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $39.81 / $63.10
| Professional | TC | $21.38 | $39.81 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $23.99 / $23.99
| Professional | 26 | $23.44 | $23.99 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | TC | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $83.18 / $208.93
| Professional | | $47.86 | $83.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $25.12 / $66.07
| Professional | 26 | $14.45 | $25.12 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $58.88 / $144.54
| Professional | TC | $32.36 | $58.88 | $144.54 |