- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $239.88 / $389.05
| Facility | | $81.28 | $239.88 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.47 / $12.02
| Facility | 26 | $10.00 | $10.47 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $81.28 / $288.40
| Facility | TC | $25.12 | $81.28 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $39.81 / $75.86
| Professional | | $23.99 | $39.81 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $9.55 / $21.38
| Professional | 26 | $7.08 | $9.55 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $21.88 / $53.70
| Professional | TC | $15.14 | $21.88 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $100.00 / $112.20
| Facility | | $81.28 | $100.00 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $42.66 / $57.54
| Professional | | $21.88 | $42.66 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $11.75 / $16.60
| Professional | 26 | $6.03 | $11.75 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $27.54 / $41.69
| Professional | TC | $15.85 | $27.54 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $39.81 / $75.86
| Professional | | $28.84 | $39.81 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $12.30 / $24.55
| Professional | 26 | $9.77 | $12.30 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $26.30 / $53.70
| Professional | TC | $18.62 | $26.30 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Professional | | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $44.67 / $85.11
| Professional | | $33.88 | $44.67 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $13.18 / $24.55
| Professional | 26 | $10.47 | $13.18 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $31.62 / $60.26
| Professional | TC | $25.70 | $31.62 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $35.48 / $4,265.80
| Facility | | $33.11 | $35.48 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $10.47 / $1,230.27
| Facility | 26 | $10.23 | $10.47 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $25.12 / $3,019.95
| Facility | TC | $22.39 | $25.12 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $66.07
| Professional | | $25.12 | $36.31 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.96 / $19.05
| Professional | 26 | $7.94 | $10.96 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $25.12 / $45.71
| Professional | TC | $17.78 | $25.12 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $42.66 / $95.50
| Professional | | $29.51 | $42.66 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $13.49 / $53.70
| Professional | 26 | $9.12 | $13.49 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $89.13
| Professional | TC | $20.42 | $28.18 | $89.13 |