- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $251.19 / $407.38
| Facility | | $100.00 | $251.19 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $8.91 / $15.14
| Facility | 26 | $7.94 | $8.91 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $28.18 / $47.86
| Facility | TC | $25.12 | $28.18 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $32.36 / $74.13
| Professional | | $17.78 | $32.36 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $32.36
| Professional | 26 | $7.08 | $10.96 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $27.54 / $74.13
| Professional | TC | $19.05 | $27.54 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $91.20
| Professional | | $61.66 | $83.18 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $19.95 / $22.39
| Professional | 26 | $15.14 | $19.95 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $165.96 / $181.97
| Professional | 50 | $125.89 | $165.96 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $63.10 / $69.18
| Professional | TC | $46.77 | $63.10 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $53.70 / $87.10
| Professional | | $33.88 | $53.70 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $12.88 / $22.39
| Professional | 26 | $8.71 | $12.88 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $41.69 / $64.57
| Professional | TC | $23.99 | $41.69 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $56.23 / $165.96
| Facility | | $34.67 | $56.23 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $87.10 / $147.91
| Facility | TC | $70.79 | $87.10 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $60.26 / $223.87
| Professional | | $33.11 | $60.26 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $17.78 / $54.95
| Professional | 26 | $9.33 | $17.78 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $43.65 / $169.82
| Professional | TC | $24.55 | $43.65 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $63.10 / $100.00
| Professional | | $34.67 | $63.10 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $16.22 / $41.69
| Professional | 26 | $9.33 | $16.22 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $39.81 / $66.07
| Professional | TC | $23.99 | $39.81 | $66.07 |