- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $436.52
| Facility | | $60.26 | $100.00 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $41.69 / $186.21
| Facility | 26 | $13.18 | $41.69 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $87.10 / $275.42
| Facility | TC | $48.98 | $87.10 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $144.54
| Professional | | $25.12 | $41.69 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.22 / $43.65
| Professional | 26 | $7.94 | $11.22 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $77.62
| Professional | TC | $18.20 | $26.92 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $52.48 / $77.62
| Facility | | $38.90 | $52.48 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $43.65 / $64.57
| Professional | | $28.84 | $43.65 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $14.45 / $22.91
| Professional | 26 | $8.71 | $14.45 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $29.51 / $44.67
| Professional | TC | $19.95 | $29.51 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $104.71 / $147.91
| Facility | | $61.66 | $104.71 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $77.62
| Professional | | $33.88 | $48.98 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $15.49 / $26.30
| Professional | 26 | $11.22 | $15.49 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $31.62 / $54.95
| Professional | TC | $20.89 | $31.62 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $38.90 / $51.29
| Professional | | $29.51 | $38.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $13.49 / $16.60
| Professional | 26 | $9.55 | $13.49 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $31.62 / $39.81
| Professional | TC | $18.62 | $31.62 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $245.47 / $269.15
| Facility | | $102.33 | $245.47 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $21.88 / $70.79
| Professional | | $14.79 | $21.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $43.65 / $100.00
| Professional | | $28.18 | $43.65 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $13.18 / $35.48
| Professional | 26 | $9.12 | $13.18 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $30.20 / $67.61
| Professional | TC | $18.62 | $30.20 | $67.61 |