- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $457.09 / $1,023.29
| Facility | | $100.00 | $457.09 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $95.50
| Facility | 26 | $19.05 | $28.84 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $302.00 / $630.96
| Facility | TC | $44.67 | $302.00 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $112.20 / $407.38
| Professional | | $61.66 | $112.20 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $40.74 / $112.20
| Professional | 26 | $22.91 | $40.74 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $67.61 / $147.91
| Professional | TC | $40.74 | $67.61 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $70.79 / $109.65
| Professional | | $53.70 | $70.79 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $44.67
| Professional | 26 | $20.89 | $26.30 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $46.77 / $70.79
| Professional | TC | $40.74 | $46.77 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $79.43 / $120.23
| Facility | | $39.81 | $79.43 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $63.10 / $85.11
| Professional | | $47.86 | $63.10 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $229.09 / $346.74
| Facility | | $67.61 | $229.09 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $36.31 / $89.13
| Facility | 26 | $6.76 | $36.31 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $64.57 / $91.20
| Facility | TC | $13.80 | $64.57 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $97.72 / $190.55
| Professional | | $60.26 | $97.72 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $60.26
| Professional | 26 | $19.95 | $30.90 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $67.61 / $128.82
| Professional | TC | $41.69 | $67.61 | $128.82 |
- 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
- $30.90 / $30.90 / $30.90
| Facility | 26 | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | TC | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $85.11 / $125.89
| Professional | | $58.88 | $85.11 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $40.74
| Professional | 26 | $19.50 | $27.54 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $58.88 / $85.11
| Professional | TC | $39.81 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $38.02 / $83.18
| Professional | | $21.88 | $38.02 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $93.33 / $251.19
| Facility | | $33.88 | $93.33 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $87.10 / $181.97
| Professional | | $69.18 | $87.10 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $27.54 / $69.18
| Professional | 26 | $22.39 | $27.54 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $61.66 / $117.49
| Professional | TC | $46.77 | $61.66 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $87.10
| Professional | | $60.26 | $60.26 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $29.51
| Professional | 26 | $19.05 | $19.05 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $60.26
| Professional | TC | $40.74 | $40.74 | $60.26 |