- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $58.88 / $100.00
| Facility | | $30.20 | $58.88 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $7.24 / $8.71
| Facility | 26 | $3.02 | $7.24 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $97.72
| Professional | | $19.05 | $28.84 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.24 / $23.99
| Professional | 26 | $2.00 | $3.24 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.59
| Professional | 52 | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $20.89 / $44.67
| Professional | TC | $15.14 | $20.89 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $21.38 / $181.97
| Professional | | $2.95 | $21.38 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.04 / $2.63 / $2.63
| Professional | 26 | $2.04 | $2.63 | $2.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.59 / $20.89 / $20.89
| Professional | TC | $12.59 | $20.89 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Facility | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $34.67 / $70.79
| Professional | | $20.42 | $34.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.63 / $4.90 / $12.02
| Professional | 26 | $2.63 | $4.90 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $30.20 / $57.54
| Professional | TC | $17.78 | $30.20 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $27.54 / $56.23
| Professional | | $23.44 | $27.54 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $3.31 / $6.76
| Professional | 26 | $2.82 | $3.31 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $24.55 / $48.98
| Professional | TC | $20.89 | $24.55 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $181.97 / $208.93
| Facility | | $154.88 | $181.97 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $72.44
| Professional | | $21.88 | $35.48 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.95 / $5.62 / $8.91
| Professional | 26 | $2.95 | $5.62 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $30.20 / $64.57
| Professional | TC | $18.62 | $30.20 | $64.57 |