- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $223.87 / $562.34
| Professional | | $169.82 | $223.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $43.65 / $107.15
| Professional | 26 | $31.62 | $43.65 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $204.17 / $380.19
| Professional | TC | $144.54 | $204.17 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $302.00
| Professional | | $58.88 | $58.88 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $70.79
| Facility | 26 | $58.88 | $58.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $302.00 / $524.81
| Professional | | $177.83 | $302.00 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $52.48 / $89.13
| Professional | 26 | $29.51 | $52.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $239.88 / $426.58
| Professional | TC | $147.91 | $239.88 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $338.84 / $537.03
| Professional | | $323.59 | $338.84 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $70.79
| Facility | 26 | $58.88 | $58.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $338.84 / $512.86
| Professional | | $245.47 | $338.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $57.54 / $72.44
| Professional | 26 | $37.15 | $57.54 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $234.42 / $346.74
| Professional | TC | $162.18 | $234.42 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $331.13 / $436.52
| Professional | | $251.19 | $331.13 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $64.57 / $87.10
| Professional | 26 | $43.65 | $64.57 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $363.08
| Professional | TC | $204.17 | $269.15 | $363.08 |