- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $144.54 / $371.54
| Facility | | $51.29 | $144.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $11.75 / $54.95
| Facility | 26 | $7.24 | $11.75 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $52.48 / $138.04
| Facility | TC | $19.95 | $52.48 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $87.10
| Professional | | $22.91 | $38.02 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $9.55 / $25.12
| Professional | 26 | $7.08 | $9.55 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $21.38 / $53.70
| Professional | TC | $15.14 | $21.38 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $22.39 / $32.36
| Professional | | $18.62 | $22.39 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $7.59 / $16.22
| Professional | 26 | $6.76 | $7.59 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $22.91
| Professional | TC | $15.14 | $19.05 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $218.78 / $1,318.26
| Facility | | $45.71 | $218.78 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $72.44
| Professional | | $37.15 | $37.15 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $19.95
| Professional | 26 | $10.23 | $10.23 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $57.54 / $100.00
| Facility | | $53.70 | $57.54 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $63.10
| Professional | | $22.91 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $11.22 / $18.62
| Professional | 26 | $6.61 | $11.22 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $25.12 / $45.71
| Professional | TC | $16.22 | $25.12 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $42.66 / $51.29
| Professional | | $30.90 | $42.66 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $11.75 / $14.13
| Professional | 26 | $8.51 | $11.75 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $30.20 / $36.31
| Professional | TC | $21.88 | $30.20 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $1,621.81 / $15,848.93
| Facility | | $141.25 | $1,621.81 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $9,332.54 / $25,703.96
| Facility | TC | $19.05 | $9,332.54 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $30.90 / $60.26
| Professional | | $23.99 | $30.90 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $8.91 / $16.98
| Professional | 26 | $7.59 | $8.91 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $23.99 / $38.90
| Professional | TC | $17.78 | $23.99 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $131.83 / $204.17
| Facility | | $81.28 | $131.83 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $56.23
| Professional | | $21.88 | $32.36 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $10.23 / $17.78
| Professional | 26 | $6.46 | $10.23 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $22.91 / $39.81
| Professional | TC | $15.14 | $22.91 | $39.81 |