- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $602.56 / $1,000.00
| Facility | | $102.33 | $602.56 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $21.88 / $42.66
| Facility | 26 | $17.78 | $21.88 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $323.59 / $616.60
| Facility | TC | $77.62 | $323.59 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $131.83 / $426.58
| Professional | | $22.39 | $131.83 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $31.62 / $87.10
| Professional | 26 | $19.50 | $31.62 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $112.20 / $218.78
| Professional | TC | $85.11 | $112.20 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $95.50 / $151.36
| Professional | | $79.43 | $95.50 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $19.50 / $30.90
| Professional | 26 | $15.85 | $19.50 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $134.90
| Professional | TC | $66.07 | $83.18 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $208.93
| Facility | | $64.57 | $107.15 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $97.72 / $112.20
| Professional | | $77.62 | $97.72 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $281.84 / $758.58
| Facility | | $123.03 | $281.84 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.13 / $26.92 / $67.61
| Facility | 26 | $5.13 | $26.92 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $104.71 / $151.36
| Facility | TC | $22.91 | $104.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $162.18 / $302.00
| Professional | | $97.72 | $162.18 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $29.51 / $54.95
| Professional | 26 | $19.50 | $29.51 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $144.54 / $263.03
| Professional | TC | $89.13 | $144.54 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $302.00 / $660.69
| Facility | | $134.90 | $302.00 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Facility | 26 | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | TC | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $128.82 / $181.97
| Professional | | $66.07 | $128.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $20.42 / $31.62
| Professional | 26 | $10.00 | $20.42 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $104.71 / $147.91
| Professional | TC | $56.23 | $104.71 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $33.11 / $134.90
| Professional | | $17.38 | $33.11 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $95.50 / $165.96
| Facility | | $16.60 | $95.50 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $147.91 / $269.15
| Professional | | $95.50 | $147.91 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $51.29
| Professional | 26 | $17.78 | $25.70 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $123.03 / $223.87
| Professional | TC | $79.43 | $123.03 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $117.49
| Professional | | $91.20 | $91.20 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $21.88
| Professional | 26 | $15.85 | $15.85 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $97.72
| Professional | TC | $74.13 | $74.13 | $97.72 |