- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $194.98 / $467.74
| Facility | | $100.00 | $194.98 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $39.81
| Facility | 26 | $32.36 | $32.36 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $97.72 / $407.38
| Professional | | $58.88 | $97.72 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $61.66 / $177.83
| Professional | 26 | $28.84 | $61.66 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $67.61 / $229.09 / $660.69
| Professional | 50 | $67.61 | $229.09 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $57.54 / $257.04
| Professional | TC | $42.66 | $57.54 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $66.07 / $125.89
| Professional | | $54.95 | $66.07 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $47.86 / $67.61
| Professional | 26 | $25.12 | $47.86 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $85.11 / $100.00 / $190.55
| Professional | 50 | $85.11 | $100.00 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $109.65 / $109.65
| Facility | | $69.18 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $95.50 / $154.88
| Professional | | $81.28 | $95.50 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $54.95
| Professional | 26 | $30.20 | $36.31 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $117.49 / $138.04 / $154.88
| Professional | 50 | $117.49 | $138.04 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $58.88 / $100.00
| Professional | TC | $50.12 | $58.88 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $169.82 / $501.19
| Facility | | $120.23 | $169.82 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $107.15 / $165.96
| Professional | | $72.44 | $107.15 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $40.74 / $63.10
| Professional | 26 | $27.54 | $40.74 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $66.07 / $102.33
| Professional | TC | $44.67 | $66.07 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $93.33 / $138.04
| Professional | | $0.72 | $93.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.27 / $35.48 / $52.48
| Professional | 26 | $0.27 | $35.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.45 / $57.54 / $87.10
| Professional | TC | $0.45 | $57.54 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $0.72 / $125.89
| Professional | | $0.72 | $0.72 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.27 / $0.27 / $46.77
| Professional | 26 | $0.27 | $0.27 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.45 / $0.45 / $77.62
| Professional | TC | $0.45 | $0.45 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $83.18 / $117.49
| Professional | | $81.28 | $83.18 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $46.77
| Professional | 26 | $30.90 | $30.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $52.48 / $70.79
| Professional | TC | $51.29 | $52.48 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $181.97
| Facility | | $89.13 | $89.13 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $89.13 / $147.91
| Professional | | $72.44 | $89.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $34.67 / $63.10
| Professional | 26 | $27.54 | $34.67 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | 50 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $54.95 / $91.20
| Professional | TC | $43.65 | $54.95 | $91.20 |