- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $275.42 / $10,000.00
| Facility | | $102.33 | $275.42 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $40.74
| Facility | 26 | $34.67 | $34.67 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $125.89 / $436.52
| Professional | | $72.44 | $125.89 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $257.04 / $537.03
| Professional | 26 | $74.13 | $257.04 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $70.79 / $257.04
| Professional | TC | $41.69 | $70.79 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $69.18 / $177.83
| Professional | | $47.86 | $69.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $26.92 / $74.13
| Professional | 26 | $23.44 | $26.92 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $42.66 / $102.33
| Professional | TC | $21.38 | $42.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $35.48
| Professional | 26 | $34.67 | $34.67 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $114.82 / $288.40
| Professional | | $77.62 | $114.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $42.66 / $97.72
| Professional | 26 | $28.84 | $42.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $66.07 / $186.21
| Professional | TC | $42.66 | $66.07 | $186.21 |