- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $912.01 / $1,148.15
| Facility | | $295.12 | $912.01 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $602.56 / $1,000.00
| Facility | TC | $398.11 | $602.56 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $117.49 / $251.19
| Professional | | $19.95 | $117.49 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $28.18 / $95.50
| Professional | 26 | $16.98 | $28.18 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $114.82 / $173.78
| Professional | TC | $77.62 | $114.82 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $213.80 / $213.80
| Professional | | $173.78 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $37.15 / $37.15
| Professional | 26 | $30.20 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $177.83 / $177.83
| Professional | TC | $144.54 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $295.12
| Professional | | $134.90 | $204.17 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $35.48 / $48.98
| Professional | 26 | $22.39 | $35.48 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $165.96 / $218.78
| Professional | TC | $114.82 | $165.96 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $60.26 / $74.13
| Facility | | $13.80 | $60.26 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $245.47 / $549.54
| Professional | | $141.25 | $245.47 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $43.65 / $81.28
| Professional | 26 | $23.44 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $199.53 / $478.63
| Professional | TC | $120.23 | $199.53 | $478.63 |