- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $812.83 / $1,000.00
| Facility | | $125.89 | $812.83 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $23.99 / $288.40
| Facility | 26 | $21.88 | $23.99 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $257.04 / $724.44
| Facility | TC | $102.33 | $257.04 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $134.90 / $436.52
| Professional | | $22.91 | $134.90 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $100.00
| Professional | 26 | $19.05 | $25.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $109.65 / $245.47
| Professional | TC | $89.13 | $109.65 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $97.72 / $177.83
| Professional | | $79.43 | $97.72 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $22.91 / $46.77
| Professional | 26 | $16.22 | $22.91 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $123.03 / $165.96
| Professional | | $117.49 | $123.03 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $29.51
| Professional | 26 | $21.88 | $21.88 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $102.33 / $138.04
| Professional | TC | $97.72 | $102.33 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $204.17 / $676.08
| Facility | | $181.97 | $204.17 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $169.82 / $251.19
| Professional | | $112.20 | $169.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $28.84 / $38.90
| Professional | 26 | $20.42 | $28.84 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $147.91 / $218.78
| Professional | TC | $97.72 | $147.91 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $114.82 / $194.98
| Professional | | $1.29 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.25 / $20.42 / $33.88
| Professional | 26 | $0.25 | $20.42 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1.05 / $95.50 / $158.49
| Professional | TC | $1.05 | $95.50 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.34 / $2.34 / $173.78
| Professional | | $2.34 | $2.34 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.45 / $0.45 / $30.20
| Professional | 26 | $0.45 | $0.45 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1.91 / $1.91 / $144.54
| Professional | TC | $1.91 | $1.91 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $186.21
| Professional | | $114.82 | $114.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $20.42 / $34.67
| Professional | 26 | $19.95 | $20.42 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $95.50 / $154.88
| Professional | TC | $93.33 | $95.50 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $269.15
| Facility | | $125.89 | $125.89 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $162.18 / $239.88
| Professional | | $100.00 | $162.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $44.67
| Professional | 26 | $19.95 | $27.54 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $144.54 / $208.93
| Professional | TC | $89.13 | $144.54 | $208.93 |