- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $83.18 / $630.96
| Facility | | $77.62 | $83.18 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $14.79 / $14.79
| Facility | 26 | $12.02 | $14.79 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $69.18 / $263.03
| Facility | TC | $66.07 | $69.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $87.10 / $346.74
| Professional | | $52.48 | $87.10 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $35.48 / $107.15
| Professional | 26 | $10.00 | $35.48 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $120.23
| Professional | TC | $42.66 | $64.57 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.37 / $10.96 / $12.88
| Professional | 26 | $5.37 | $10.96 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Professional | TC | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $93.33 / $97.72
| Professional | | $79.43 | $93.33 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $14.13 / $21.88
| Professional | 26 | $13.80 | $14.13 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $77.62 / $83.18
| Professional | TC | $60.26 | $77.62 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $77.62 / $77.62
| Facility | | $37.15 | $77.62 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $66.07 / $66.07
| Facility | TC | $64.57 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $11.22 / $11.22
| Professional | 26 | $10.96 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $36.31 / $120.23
| Professional | | $32.36 | $36.31 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.50 / $8.32 / $19.50
| Professional | 26 | $5.50 | $8.32 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $30.90 / $100.00
| Professional | TC | $25.70 | $30.90 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $74.13 / $128.82
| Professional | | $33.11 | $74.13 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $12.59 / $22.39
| Professional | 26 | $7.41 | $12.59 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $61.66 / $107.15
| Professional | TC | $30.20 | $61.66 | $107.15 |