- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $25.70
| Facility | | $19.05 | $19.05 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $3.02
| Facility | 26 | $2.00 | $2.00 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $22.39 / $45.71
| Professional | | $16.98 | $22.39 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $7.94
| Professional | 26 | $2.00 | $3.02 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $30.20
| Professional | TC | $15.85 | $19.05 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Facility | | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Professional | | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $31.62 / $53.70
| Professional | | $18.20 | $31.62 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.75 / $5.89 / $16.22
| Professional | 26 | $2.75 | $5.89 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $25.70 / $39.81
| Professional | TC | $15.49 | $25.70 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $32.36 / $33.11
| Professional | | $15.49 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $67.61 / $97.72
| Facility | | $46.77 | $67.61 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $23.99 / $52.48
| Professional | | $18.20 | $23.99 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $3.63 / $13.80
| Professional | 26 | $2.82 | $3.63 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $19.95 / $38.90
| Professional | TC | $15.14 | $19.95 | $38.90 |