- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $194.98 / $389.05
| Facility | | $61.66 | $194.98 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $194.98 / $389.05
| Facility | 26 | $83.18 | $194.98 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $83.18 / $208.93
| Professional | | $40.74 | $83.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $42.66 / $114.82
| Professional | 26 | $25.12 | $42.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $186.21 / $363.08
| Professional | 50 | $100.00 | $186.21 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $25.70 / $64.57
| Professional | TC | $14.13 | $25.70 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $46.77 / $70.79
| Professional | | $36.31 | $46.77 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Professional | 50 | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $234.42 / $1,621.81
| Facility | | $125.89 | $234.42 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $302.00
| Professional | | $54.95 | $70.79 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $47.86 / $89.13
| Facility | | $44.67 | $47.86 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $97.72 / $186.21
| Professional | | $45.71 | $97.72 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $52.48 / $93.33
| Professional | 26 | $26.30 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $45.71 / $91.20
| Professional | TC | $15.85 | $45.71 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $66.07 / $93.33
| Professional | | $50.12 | $66.07 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $40.74 / $56.23
| Professional | 26 | $30.90 | $40.74 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $36.31
| Professional | TC | $19.05 | $25.12 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $338.84 / $537.03
| Facility | | $213.80 | $338.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $60.26 / $177.83
| Professional | | $43.65 | $60.26 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $36.31 / $100.00
| Professional | 26 | $26.30 | $36.31 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $77.62
| Professional | TC | $19.05 | $25.70 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $177.83 / $302.00
| Facility | | $120.23 | $177.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $69.18 / $131.83
| Professional | | $38.02 | $69.18 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $38.90 / $70.79
| Professional | 26 | $22.91 | $38.90 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $26.92 / $60.26
| Professional | TC | $14.79 | $26.92 | $60.26 |