- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $7.94 / $35.48
| Facility | 26 | $5.75 | $7.94 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $41.69 / $263.03
| Facility | TC | $23.99 | $41.69 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $38.90 / $93.33
| Professional | | $14.13 | $38.90 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $10.23 / $26.30
| Professional | 26 | $5.01 | $10.23 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $31.62 / $109.65 / $162.18
| Professional | 50 | $31.62 | $109.65 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $10.47 / $33.88 / $67.61
| Professional | 52 | $10.47 | $33.88 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $74.13
| Professional | TC | $22.91 | $33.11 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $61.66
| Professional | | $25.12 | $36.31 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.90 / $6.31 / $15.14
| Professional | 26 | $4.90 | $6.31 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $67.61
| Professional | 50 | $63.10 | $63.10 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $30.90 / $41.69
| Professional | TC | $23.99 | $30.90 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $33.88 / $72.44
| Professional | | $23.99 | $33.88 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $10.47 / $16.60
| Professional | 26 | $6.61 | $10.47 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $37.15 / $69.18
| Professional | TC | $23.99 | $37.15 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $8.13
| Facility | 26 | $8.13 | $8.13 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Facility | TC | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $37.15 / $70.79
| Professional | | $23.99 | $37.15 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $9.12 / $15.14
| Professional | 26 | $5.75 | $9.12 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Professional | 50 | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $29.51 / $58.88
| Professional | TC | $17.78 | $29.51 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | TC | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $323.59 / $323.59
| Professional | | $239.88 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $54.95 / $54.95
| Professional | 26 | $53.70 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $269.15 / $269.15
| Professional | TC | $199.53 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $36.31 / $66.07
| Professional | | $24.55 | $36.31 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $7.76 / $13.80
| Professional | 26 | $6.46 | $7.76 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $28.84 / $53.70
| Professional | TC | $17.78 | $28.84 | $53.70 |