- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $724.44 / $1,000.00
| Facility | | $64.57 | $724.44 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $33.11 / $33.11
| Facility | 26 | $28.84 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $93.33 / $316.23
| Professional | | $51.29 | $93.33 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $45.71 / $104.71
| Professional | 26 | $26.30 | $45.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $35.48 / $263.03
| Professional | TC | $22.39 | $35.48 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $41.69 / $81.28
| Facility | | $27.54 | $41.69 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $50.12 / $87.10
| Professional | | $26.30 | $50.12 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $93.33
| Facility | | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $34.67 / $48.98
| Facility | 26 | $7.41 | $34.67 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $123.03 / $602.56
| Professional | | $46.77 | $123.03 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $44.67 / $158.49
| Professional | 26 | $24.55 | $44.67 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $53.70 / $489.78
| Professional | TC | $21.38 | $53.70 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $53.70 / $79.43
| Professional | 26 | $47.86 | $53.70 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $114.82 / $269.15
| Professional | | $48.98 | $114.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $70.79
| Professional | 26 | $24.55 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $83.18 / $199.53
| Professional | TC | $20.42 | $83.18 | $199.53 |