- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $269.15 / $446.68
| Facility | | $100.00 | $269.15 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $7.94 / $13.49
| Facility | 26 | $7.08 | $7.94 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $42.66 / $190.55
| Facility | TC | $21.88 | $42.66 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $33.11 / $69.18
| Professional | | $16.22 | $33.11 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $15.14 / $34.67
| Professional | 26 | $6.03 | $15.14 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $33.11 / $56.23 / $100.00
| Professional | 50 | $33.11 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $32.36 / $67.61
| Professional | TC | $16.98 | $32.36 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $74.13 / $81.28
| Professional | | $54.95 | $74.13 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $17.78 / $19.95
| Professional | 26 | $13.49 | $17.78 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $109.65 / $147.91 / $162.18
| Professional | 50 | $109.65 | $147.91 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $56.23 / $61.66
| Professional | TC | $41.69 | $56.23 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $47.86 / $75.86
| Professional | | $30.90 | $47.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $12.02 / $19.50
| Professional | 26 | $8.13 | $12.02 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $37.15 / $56.23
| Professional | TC | $20.89 | $37.15 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $53.70 / $186.21
| Facility | | $30.90 | $53.70 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $91.20 / $107.15
| Facility | TC | $75.86 | $91.20 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $53.70 / $204.17
| Professional | | $29.51 | $53.70 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $16.22 / $75.86
| Professional | 26 | $9.33 | $16.22 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $38.02 / $162.18
| Professional | TC | $21.38 | $38.02 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $54.95 / $100.00
| Professional | | $29.51 | $54.95 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $14.13 / $26.92
| Professional | 26 | $8.32 | $14.13 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $40.74 / $100.00
| Professional | TC | $21.38 | $40.74 | $100.00 |