- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $29.51 / $36.31
| Facility | 26 | $20.89 | $29.51 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $162.18 / $489.78
| Facility | TC | $58.88 | $162.18 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $75.86 / $229.09
| Professional | | $44.67 | $75.86 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $22.39 / $57.54
| Professional | 26 | $12.59 | $22.39 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $29.51 / $75.86 / $100.00
| Professional | 50 | $29.51 | $75.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $109.65
| Professional | TC | $30.90 | $48.98 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $81.28 / $275.42
| Professional | | $52.48 | $81.28 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $22.91 / $77.62
| Professional | 26 | $13.80 | $22.91 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $77.62 / $125.89 / $416.87
| Professional | 50 | $77.62 | $125.89 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $58.88 / $199.53
| Professional | TC | $38.02 | $58.88 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $47.86 / $66.07
| Professional | | $17.78 | $47.86 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $43.65 / $69.18
| Facility | 26 | $37.15 | $43.65 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $128.82 / $204.17
| Facility | TC | $109.65 | $128.82 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $144.54 / $218.78
| Professional | | $53.70 | $144.54 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $36.31 / $57.54
| Professional | 26 | $15.85 | $36.31 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $109.65 / $162.18
| Professional | TC | $38.02 | $109.65 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $467.74 / $616.60
| Facility | TC | $380.19 | $467.74 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $120.23 / $158.49
| Professional | | $100.00 | $120.23 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $31.62 / $41.69
| Professional | 26 | $25.70 | $31.62 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $85.11 / $112.20
| Professional | TC | $74.13 | $85.11 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $354.81
| Facility | 26 | $70.79 | $70.79 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $389.05 / $707.95
| Facility | TC | $181.97 | $389.05 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $95.50 / $346.74
| Professional | | $51.29 | $95.50 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $29.51 / $89.13
| Professional | 26 | $15.14 | $29.51 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $64.57 / $257.04
| Professional | TC | $36.31 | $64.57 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $138.04 / $199.53
| Professional | | $67.61 | $138.04 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $36.31 / $53.70
| Professional | 26 | $20.42 | $36.31 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $102.33 / $147.91
| Professional | TC | $53.70 | $102.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $128.82 / $190.55
| Professional | | $64.57 | $128.82 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $89.13 / $89.13
| Facility | 26 | $33.11 | $89.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $257.04 / $257.04
| Facility | TC | $93.33 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $251.19 / $346.74
| Professional | | $57.54 | $251.19 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $74.13 / $89.13
| Professional | 26 | $17.78 | $74.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $177.83 / $257.04
| Professional | TC | $39.81 | $177.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Professional | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | 26 | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Professional | TC | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $245.47 / $338.84
| Professional | | $95.50 | $245.47 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $33.11 / $51.29
| Professional | 26 | $28.18 | $33.11 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $72.44 / $141.25
| Professional | TC | $61.66 | $72.44 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $398.11
| Professional | | $74.13 | $117.49 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $87.10 / $109.65
| Professional | 26 | $26.30 | $87.10 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $61.66 / $154.88
| Professional | TC | $37.15 | $61.66 | $154.88 |