- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $144.54 / $269.15
| Facility | | $38.90 | $144.54 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $12.30
| Facility | 26 | $11.48 | $11.48 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $239.88
| Facility | TC | $25.70 | $38.90 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $45.71 / $138.04
| Professional | | $28.84 | $45.71 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $16.22 / $43.65
| Professional | 26 | $8.91 | $16.22 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $61.66
| Professional | TC | $19.05 | $28.84 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $33.11
| Professional | | $21.88 | $27.54 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $12.59 / $18.62
| Professional | 26 | $7.76 | $12.59 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $38.90
| Professional | TC | $16.98 | $21.88 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $100.00
| Facility | | $38.90 | $57.54 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $48.98 / $52.48
| Professional | | $39.81 | $48.98 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $20.89
| Professional | 26 | $15.49 | $15.49 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $50.12
| Professional | TC | $37.15 | $37.15 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $27.54 / $48.98
| Facility | | $11.22 | $27.54 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $27.54 / $46.77
| Professional | | $10.72 | $27.54 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $41.69 / $75.86
| Professional | | $26.30 | $41.69 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $13.18 / $24.55
| Professional | 26 | $7.94 | $13.18 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $29.51 / $60.26
| Professional | TC | $18.20 | $29.51 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $144.54 / $269.15
| Facility | | $37.15 | $144.54 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $25.12
| Facility | 26 | $11.48 | $11.48 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $52.48 / $239.88
| Facility | TC | $25.70 | $52.48 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $42.66 / $97.72
| Professional | | $28.84 | $42.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $13.80 / $36.31
| Professional | 26 | $8.91 | $13.80 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.18 / $58.88
| Professional | TC | $19.05 | $28.18 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.02 / $61.66
| Professional | | $26.30 | $38.02 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $12.59 / $21.38
| Professional | 26 | $8.32 | $12.59 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.12 / $48.98
| Professional | TC | $18.20 | $25.12 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $107.15 / $275.42
| Facility | | $26.92 | $107.15 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $38.90 / $97.72
| Professional | | $29.51 | $38.90 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.59 / $79.43
| Professional | 26 | $10.00 | $12.59 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $25.70 / $95.50
| Professional | TC | $19.95 | $25.70 | $95.50 |