- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.00 / $19.50
| Facility | 26 | $6.03 | $10.00 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $89.13 / $575.44
| Facility | TC | $25.12 | $89.13 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $34.67 / $91.20
| Professional | | $12.88 | $34.67 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.23 / $25.70
| Professional | 26 | $6.03 | $10.23 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $48.98 / $109.65 / $154.88
| Professional | 50 | $48.98 | $109.65 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $26.30 / $33.88 / $67.61
| Professional | 52 | $26.30 | $33.88 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $64.57
| Professional | TC | $22.91 | $33.11 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $48.98 / $75.86
| Professional | | $32.36 | $48.98 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $8.51 / $13.18
| Professional | 26 | $6.17 | $8.51 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $114.82
| Professional | 50 | $51.29 | $74.13 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $39.81 / $61.66
| Professional | TC | $25.70 | $39.81 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $39.81 / $70.79
| Professional | | $7.59 | $39.81 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $7.08 / $10.00
| Professional | 26 | $6.46 | $7.08 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $38.02 / $54.95
| Professional | TC | $27.54 | $38.02 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $10.96
| Facility | 26 | $10.96 | $10.96 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | TC | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $75.86
| Professional | | $25.70 | $38.02 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $7.94 / $14.45
| Professional | 26 | $5.25 | $7.94 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $29.51 / $63.10
| Professional | TC | $19.05 | $29.51 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $46.77 / $57.54
| Professional | | $38.90 | $46.77 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $7.76 / $9.77
| Professional | 26 | $6.17 | $7.76 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $47.86
| Professional | TC | $32.36 | $38.90 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $36.31 / $81.28
| Professional | | $28.84 | $36.31 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $11.75 / $14.45
| Professional | 26 | $9.33 | $11.75 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $60.26
| Professional | | $19.95 | $19.95 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $37.15 / $107.15
| Professional | | $8.51 | $37.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $8.91 / $15.14
| Professional | 26 | $6.61 | $8.91 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $35.48 / $66.07
| Professional | TC | $23.99 | $35.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $38.02 / $79.43
| Professional | | $21.88 | $38.02 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $7.94 / $16.22
| Professional | 26 | $5.25 | $7.94 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $28.84 / $57.54
| Professional | TC | $16.22 | $28.84 | $57.54 |