- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $588.84 / $2,511.89
| Facility | | $102.33 | $588.84 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $34.67
| Facility | 26 | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Facility | TC | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $147.91 / $1,000.00
| Professional | | $64.57 | $147.91 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $117.49 / $741.31
| Professional | 26 | $23.44 | $117.49 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $58.88 / $213.80
| Professional | TC | $39.81 | $58.88 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $85.11 / $89.13
| Professional | | $44.67 | $85.11 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $36.31
| Professional | 26 | $25.70 | $32.36 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Professional | TC | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $60.26
| Professional | | $37.15 | $37.15 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $17.38
| Professional | 26 | $11.22 | $11.22 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $46.77
| Professional | TC | $25.70 | $25.70 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $81.28 / $123.03
| Facility | | $34.67 | $81.28 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $64.57 / $117.49
| Professional | | $30.90 | $64.57 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $50.12 / $70.79
| Facility | 26 | $10.72 | $50.12 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $75.86 / $107.15
| Facility | TC | $16.22 | $75.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $79.43 / $446.68
| Professional | | $41.69 | $79.43 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $26.30 / $128.82
| Professional | 26 | $12.88 | $26.30 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $56.23 / $323.59
| Professional | TC | $28.84 | $56.23 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $44.67 / $74.13
| Facility | | $29.51 | $44.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $85.11 / $169.82
| Professional | | $52.48 | $85.11 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $29.51 / $79.43
| Professional | 26 | $17.78 | $29.51 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $56.23 / $100.00
| Professional | TC | $34.67 | $56.23 | $100.00 |