- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $28.18 / $57.54
| Facility | 26 | $21.38 | $28.18 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $316.23 / $426.58
| Facility | TC | $89.13 | $316.23 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $41.69 / $107.15
| Professional | | $12.88 | $41.69 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $8.91 / $24.55
| Professional | 26 | $5.01 | $8.91 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $107.15 / $186.21 / $186.21
| Professional | 50 | $107.15 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Professional | 52 | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $42.66 / $89.13
| Professional | TC | $19.95 | $42.66 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $57.54 / $107.15
| Professional | | $25.12 | $57.54 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $10.96 / $22.91
| Professional | 26 | $7.24 | $10.96 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $44.67 / $85.11
| Professional | TC | $18.20 | $44.67 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $28.18 / $57.54
| Facility | 26 | $21.38 | $28.18 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $316.23 / $562.34
| Facility | TC | $77.62 | $316.23 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $97.72 / $154.88
| Professional | | $30.90 | $97.72 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $19.50 / $47.86
| Professional | 26 | $6.92 | $19.50 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $107.15 / $186.21 / $295.12
| Professional | 50 | $107.15 | $186.21 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Professional | 52 | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $81.28 / $158.49
| Professional | TC | $29.51 | $81.28 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $154.88 / $218.78
| Professional | | $147.91 | $154.88 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $26.92 / $44.67
| Professional | 26 | $25.12 | $26.92 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $177.83
| Professional | TC | $89.13 | $128.82 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $91.20 / $107.15
| Professional | | $34.67 | $91.20 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $9.55 / $23.99
| Professional | 26 | $5.75 | $9.55 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $35.48 / $85.11
| Professional | TC | $19.05 | $35.48 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $83.18 / $177.83
| Professional | | $36.31 | $83.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $19.50 / $41.69
| Professional | 26 | $7.41 | $19.50 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $64.57 / $138.04
| Professional | TC | $27.54 | $64.57 | $138.04 |