- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $218.78 / $269.15
| Facility | | $100.00 | $218.78 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $53.70 / $53.70
| Facility | 26 | $19.95 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $177.83
| Professional | | $38.90 | $61.66 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $33.11 / $77.62
| Professional | 26 | $25.70 | $33.11 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $56.23 / $147.91 / $331.13
| Professional | 50 | $56.23 | $147.91 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $28.84 / $85.11
| Professional | TC | $15.14 | $28.84 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $45.71 / $63.10
| Professional | | $41.69 | $45.71 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $28.84 / $35.48
| Professional | 26 | $26.92 | $28.84 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Professional | 50 | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $15.49 / $16.60
| Professional | TC | $14.79 | $15.49 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $100.00 / $302.00
| Professional | | $50.12 | $100.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $69.18 / $95.50
| Professional | 26 | $26.92 | $69.18 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $95.50 / $162.18
| Professional | | $43.65 | $95.50 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $38.02 / $67.61
| Professional | 26 | $23.99 | $38.02 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $57.54 / $104.71
| Professional | TC | $15.85 | $57.54 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $95.50
| Professional | | $54.95 | $70.79 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $43.65 / $58.88
| Professional | 26 | $33.88 | $43.65 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $26.92 / $37.15
| Professional | TC | $21.88 | $26.92 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $416.87 / $660.69
| Facility | | $269.15 | $416.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $61.66 / $158.49
| Professional | | $48.98 | $61.66 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $32.36 / $67.61
| Professional | 26 | $25.12 | $32.36 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $35.48 / $114.82
| Professional | TC | $26.30 | $35.48 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $79.43 / $562.34
| Facility | | $30.20 | $79.43 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $64.57 / $120.23
| Professional | | $33.11 | $64.57 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $31.62 / $56.23
| Professional | 26 | $18.20 | $31.62 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.18 / $32.36 / $69.18
| Professional | TC | $13.18 | $32.36 | $69.18 |