- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $407.38 / $831.76
| Facility | | $97.72 | $407.38 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $21.38 / $97.72
| Facility | 26 | $18.62 | $21.38 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $144.54 / $426.58
| Professional | | $79.43 | $144.54 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $38.90 / $100.00
| Professional | 26 | $20.89 | $38.90 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $28.18 / $83.18 / $239.88
| Professional | 52 | $28.18 | $83.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $89.13 / $190.55
| Professional | TC | $56.23 | $89.13 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $134.90
| Professional | | $70.79 | $89.13 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $25.70 / $48.98
| Professional | 26 | $20.42 | $25.70 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $61.66 / $102.33
| Professional | TC | $48.98 | $61.66 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $109.65 / $169.82
| Facility | | $54.95 | $109.65 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $85.11 / $102.33
| Professional | | $66.07 | $85.11 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $245.47 / $346.74
| Facility | | $138.04 | $245.47 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $34.67 / $83.18
| Facility | 26 | $6.61 | $34.67 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $229.09
| Professional | | $75.86 | $107.15 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $30.20 / $60.26
| Professional | 26 | $19.50 | $30.20 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $85.11 / $181.97
| Professional | TC | $56.23 | $85.11 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $144.54 / $316.23
| Facility | | $56.23 | $144.54 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Facility | 26 | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $91.20 / $154.88
| Professional | | $64.57 | $91.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $25.70 / $39.81
| Professional | 26 | $11.75 | $25.70 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $67.61 / $117.49
| Professional | TC | $33.88 | $67.61 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $46.77 / $114.82
| Professional | | $21.38 | $46.77 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $97.72 / $251.19
| Facility | | $33.88 | $97.72 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $100.00 / $218.78
| Professional | | $83.18 | $100.00 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $64.57
| Professional | 26 | $20.89 | $26.30 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $77.62 / $162.18
| Professional | TC | $63.10 | $77.62 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $112.20
| Professional | | $75.86 | $75.86 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $28.18
| Professional | 26 | $18.62 | $18.62 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $83.18
| Professional | TC | $57.54 | $57.54 | $83.18 |