- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $562.34 / $1,000.00
| Facility | | $97.72 | $562.34 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $31.62 / $58.88
| Facility | 26 | $28.18 | $31.62 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $309.03 / $630.96
| Facility | TC | $75.86 | $309.03 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $37.15 / $102.33
| Professional | | $19.05 | $37.15 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.00 / $34.67
| Professional | 26 | $7.08 | $10.00 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $28.18 / $75.86
| Professional | TC | $16.98 | $28.18 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $54.95 / $102.33
| Professional | | $36.31 | $54.95 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $15.14 / $30.20
| Professional | 26 | $10.72 | $15.14 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $74.13
| Professional | TC | $25.70 | $38.02 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $72.44 / $758.58
| Facility | | $30.20 | $72.44 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $31.62 / $89.13
| Facility | 26 | $27.54 | $31.62 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $147.91 / $630.96
| Facility | TC | $69.18 | $147.91 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $89.13 / $199.53
| Professional | | $31.62 | $89.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $25.70 / $51.29
| Professional | 26 | $8.91 | $25.70 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $67.61 / $117.49
| Professional | TC | $26.30 | $67.61 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $144.54 / $208.93
| Professional | | $134.90 | $144.54 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $35.48 / $57.54
| Professional | 26 | $32.36 | $35.48 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $109.65 / $151.36
| Professional | TC | $85.11 | $109.65 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $43.65 / $81.28
| Facility | | $28.84 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $83.18 / $102.33
| Professional | | $38.90 | $83.18 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $12.30 / $32.36
| Professional | 26 | $7.41 | $12.30 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $32.36 / $74.13
| Professional | TC | $22.39 | $32.36 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $83.18 / $177.83
| Professional | | $41.69 | $83.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $25.70 / $54.95
| Professional | 26 | $9.77 | $25.70 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $57.54 / $114.82
| Professional | TC | $30.90 | $57.54 | $114.82 |