- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $309.03 / $549.54
| Facility | | $72.44 | $309.03 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.96 / $19.05
| Facility | 26 | $10.00 | $10.96 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $30.90 / $407.38
| Facility | TC | $25.70 | $30.90 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $100.00
| Professional | | $30.90 | $52.48 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.13 / $34.67
| Professional | 26 | $8.91 | $14.13 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $44.67 / $213.80
| Professional | TC | $22.91 | $44.67 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $91.20 / $102.33
| Professional | | $69.18 | $91.20 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $24.55 / $27.54
| Professional | 26 | $18.62 | $24.55 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $66.07 / $74.13
| Professional | TC | $50.12 | $66.07 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $60.26 / $95.50
| Professional | | $39.81 | $60.26 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $16.60 / $26.92
| Professional | 26 | $10.72 | $16.60 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $67.61
| Professional | TC | $28.18 | $44.67 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $69.18 / $263.03
| Facility | | $38.02 | $69.18 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $147.91 / $213.80
| Facility | TC | $93.33 | $147.91 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $66.07 / $257.04
| Professional | | $36.31 | $66.07 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $22.39 / $83.18
| Professional | 26 | $13.49 | $22.39 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $46.77 / $208.93
| Professional | TC | $26.30 | $46.77 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $70.79 / $100.00
| Professional | | $38.90 | $70.79 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $19.50 / $37.15
| Professional | 26 | $11.22 | $19.50 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $50.12 / $100.00
| Professional | TC | $26.92 | $50.12 | $100.00 |