- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $181.97 / $467.74
| Facility | | $30.20 | $181.97 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $8.91 / $14.13
| Facility | 26 | $7.41 | $8.91 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $25.70 / $42.66
| Facility | TC | $21.38 | $25.70 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $33.11 / $100.00
| Professional | | $12.59 | $33.11 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.72 / $32.36
| Professional | 26 | $7.08 | $10.72 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $23.99 / $100.00 / $162.18
| Professional | 50 | $23.99 | $100.00 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $13.49 / $23.44 / $57.54
| Professional | 52 | $13.49 | $23.44 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $23.99 / $47.86
| Professional | TC | $16.98 | $23.99 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $25.12 / $38.02
| Professional | | $22.91 | $25.12 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $7.59 / $12.30
| Professional | 26 | $5.75 | $7.59 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $48.98
| Professional | 50 | $42.66 | $42.66 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Professional | TC | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $28.18 / $47.86
| Professional | | $25.12 | $28.18 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $8.51 / $15.14
| Professional | 26 | $8.32 | $8.51 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $37.15 / $41.69 / $70.79
| Professional | 50 | $37.15 | $41.69 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $18.62 / $32.36
| Professional | TC | $16.60 | $18.62 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $28.18 / $40.74
| Facility | | $7.94 | $28.18 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $22.91 / $37.15
| Professional | | $7.94 | $22.91 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $85.11
| Facility | | $50.12 | $50.12 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.86 / $8.71 / $12.59
| Facility | 26 | $1.86 | $8.71 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.62 / $26.30 / $38.02
| Facility | TC | $5.62 | $26.30 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $43.65 / $151.36
| Professional | | $25.12 | $43.65 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $12.59 / $39.81
| Professional | 26 | $7.24 | $12.59 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $32.36 / $114.82
| Professional | TC | $18.62 | $32.36 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $32.36 / $33.11
| Professional | | $7.08 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $22.91 / $66.07
| Facility | | $6.92 | $22.91 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $29.51 / $51.29
| Professional | | $23.99 | $29.51 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $8.71 / $15.49
| Professional | 26 | $7.24 | $8.71 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | 52 | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $20.89 / $37.15
| Professional | TC | $16.60 | $20.89 | $37.15 |