- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $251.19 / $707.95
| Facility | | $48.98 | $251.19 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $8.13 / $14.13
| Facility | 26 | $7.24 | $8.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $100.00 / $467.74
| Facility | TC | $19.05 | $100.00 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $29.51 / $63.10
| Professional | | $8.91 | $29.51 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.02 / $43.65
| Professional | 26 | $7.59 | $12.02 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $16.60 / $77.62 / $120.23
| Professional | 50 | $16.60 | $77.62 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $30.90 / $64.57
| Professional | TC | $19.05 | $30.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $42.66
| Professional | | $21.88 | $28.84 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $8.71 / $11.75
| Professional | 26 | $6.76 | $8.71 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $31.62 / $37.15 / $57.54
| Professional | 50 | $31.62 | $37.15 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $26.30 / $30.90
| Professional | TC | $24.55 | $26.30 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $102.33
| Facility | | $51.29 | $72.44 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $31.62 / $43.65
| Professional | | $9.12 | $31.62 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $107.15 / $107.15
| Facility | | $33.11 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $8.51 / $13.49
| Facility | 26 | $8.51 | $8.51 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $28.84
| Facility | TC | $15.85 | $15.85 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $30.20 / $48.98
| Professional | | $23.99 | $30.20 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $9.12 / $15.14
| Professional | 26 | $7.76 | $9.12 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $21.88 / $32.36
| Professional | TC | $15.49 | $21.88 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $45.71 / $269.15
| Facility | | $26.30 | $45.71 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $100.00 / $100.00
| Facility | 26 | $20.89 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $117.49 / $194.98
| Facility | TC | $104.71 | $117.49 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $35.48 / $223.87
| Professional | | $26.92 | $35.48 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $10.00 / $89.13
| Professional | 26 | $8.32 | $10.00 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $22.91 / $177.83
| Professional | TC | $17.78 | $22.91 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $70.79 / $208.93
| Facility | | $18.62 | $70.79 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $31.62 / $57.54
| Professional | | $26.30 | $31.62 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $9.33 / $16.60
| Professional | 26 | $8.32 | $9.33 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $22.39 / $40.74
| Professional | TC | $17.78 | $22.39 | $40.74 |