- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $100.00 / $398.11
| Facility | | $36.31 | $100.00 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $11.48 / $21.88
| Facility | 26 | $10.00 | $11.48 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $44.67 / $281.84
| Facility | TC | $26.30 | $44.67 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $37.15 / $63.10
| Professional | | $26.92 | $37.15 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.22 / $26.92
| Professional | 26 | $7.94 | $11.22 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $23.99 / $38.02
| Professional | TC | $18.20 | $23.99 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $23.99 / $52.48
| Professional | | $20.42 | $23.99 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $7.41 / $10.72
| Professional | 26 | $7.24 | $7.41 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $16.98 / $27.54
| Professional | TC | $16.22 | $16.98 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $125.89 / $177.83
| Facility | | $100.00 | $125.89 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $128.82 / $239.88
| Facility | | $70.79 | $128.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $39.81 / $61.66
| Professional | | $23.99 | $39.81 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $13.18 / $19.95
| Professional | 26 | $8.32 | $13.18 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $29.51 / $44.67
| Professional | TC | $18.20 | $29.51 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $93.33
| Facility | | $32.36 | $45.71 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $100.00
| Facility | 26 | $22.91 | $22.91 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $107.15 / $281.84
| Facility | TC | $48.98 | $107.15 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $41.69 / $218.78
| Professional | | $30.90 | $41.69 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $12.88 / $87.10
| Professional | 26 | $10.23 | $12.88 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $28.18 / $204.17
| Professional | TC | $20.89 | $28.18 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $79.43 / $208.93
| Facility | | $31.62 | $79.43 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $57.54
| Professional | | $30.20 | $35.48 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $11.48 / $19.05
| Professional | 26 | $10.00 | $11.48 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $23.99 / $38.02
| Professional | TC | $20.42 | $23.99 | $38.02 |