- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $331.13 / $588.84
| Facility | | $95.50 | $331.13 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $10.00
| Facility | 26 | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $245.47 / $407.38
| Facility | TC | $117.49 | $245.47 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $51.29 / $102.33
| Professional | | $30.90 | $51.29 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $10.96 / $29.51
| Professional | 26 | $9.77 | $10.96 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $31.62 / $100.00
| Professional | TC | $20.89 | $31.62 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $58.88 / $194.98
| Facility | | $33.88 | $58.88 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $52.48 / $60.26
| Professional | | $33.88 | $52.48 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $100.00
| Professional | | $64.57 | $79.43 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $29.51
| Professional | 26 | $19.05 | $23.99 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $56.23 / $70.79
| Professional | TC | $44.67 | $56.23 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $104.71 / $467.74
| Facility | | $40.74 | $104.71 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Facility | TC | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $89.13
| Professional | | $28.18 | $45.71 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $20.42 / $26.30
| Professional | 26 | $13.49 | $20.42 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $29.51 / $54.95
| Professional | TC | $19.50 | $29.51 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $70.79 / $72.44
| Professional | | $66.07 | $70.79 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $21.88 / $25.70
| Professional | 26 | $20.89 | $21.88 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $50.12
| Professional | TC | $44.67 | $44.67 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Professional | 26 | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Professional | TC | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $54.95 / $66.07
| Professional | | $39.81 | $54.95 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $17.78 / $19.95
| Professional | 26 | $12.59 | $17.78 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $39.81 / $45.71
| Professional | TC | $27.54 | $39.81 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $75.86
| Professional | | $33.88 | $51.29 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $18.62 / $28.18
| Professional | 26 | $12.30 | $18.62 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $52.48
| Professional | TC | $21.88 | $35.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $67.61 / $67.61
| Professional | | $57.54 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $20.89 / $20.89
| Professional | 26 | $17.78 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $46.77
| Professional | TC | $39.81 | $46.77 | $46.77 |