- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $7.59 / $74.13
| Facility | 26 | $6.03 | $7.59 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $162.18 / $371.54
| Facility | TC | $37.15 | $162.18 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $44.67 / $154.88
| Professional | | $19.05 | $44.67 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.96 / $39.81
| Professional | 26 | $6.03 | $10.96 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Professional | 50 | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Professional | 52 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $36.31 / $72.44
| Professional | TC | $23.44 | $36.31 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $28.18 / $45.71
| Professional | | $25.70 | $28.18 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.13 / $5.37 / $10.23
| Professional | 26 | $5.13 | $5.37 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $47.86 / $47.86
| Professional | TC | $38.02 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $35.48 / $58.88
| Professional | | $30.90 | $35.48 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $6.31 / $10.96
| Professional | 26 | $6.31 | $6.31 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $42.66 / $50.12 / $64.57
| Professional | 50 | $42.66 | $50.12 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $29.51 / $47.86
| Professional | TC | $23.99 | $29.51 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.90 / $64.57
| Professional | | $26.30 | $38.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $8.32 / $11.75
| Professional | 26 | $5.62 | $8.32 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $31.62 / $53.70
| Professional | TC | $19.50 | $31.62 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $46.77 / $63.10
| Professional | | $0.19 | $46.77 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.07 / $7.94 / $10.72
| Professional | 26 | $0.07 | $7.94 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.12 / $38.90 / $52.48
| Professional | TC | $0.12 | $38.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.19 / $0.19 / $58.88
| Professional | | $0.19 | $0.19 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.07 / $0.07 / $10.00
| Professional | 26 | $0.07 | $0.07 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.12 / $0.12 / $48.98
| Professional | TC | $0.12 | $0.12 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $38.90 / $38.90
| Professional | | $37.15 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $6.61 / $6.76
| Professional | 26 | $6.46 | $6.61 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $32.36 / $32.36
| Professional | TC | $30.90 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $64.57
| Professional | | $21.88 | $36.31 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.57 / $7.24 / $12.88
| Professional | 26 | $4.57 | $7.24 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $28.84 / $51.29
| Professional | TC | $15.49 | $28.84 | $51.29 |