- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $11.75
| Facility | 26 | $7.08 | $7.08 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $32.36 / $102.33
| Professional | | $15.49 | $32.36 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $13.49 / $34.67
| Professional | 26 | $6.92 | $13.49 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $38.90 / $81.28 / $117.49
| Professional | 50 | $38.90 | $81.28 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $15.85 / $27.54 / $30.20
| Professional | 52 | $15.85 | $27.54 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $26.92 / $64.57
| Professional | TC | $16.98 | $26.92 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.37 / $6.46 / $6.46
| Facility | 26 | $5.37 | $6.46 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $70.79 / $102.33
| Professional | | $46.77 | $70.79 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $19.05 / $27.54
| Professional | 26 | $12.59 | $19.05 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $54.95 / $74.13
| Professional | TC | $34.67 | $54.95 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $26.92 / $66.07
| Facility | 26 | $11.75 | $26.92 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $54.95 / $87.10
| Professional | | $30.90 | $54.95 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.13 / $22.91
| Professional | 26 | $8.91 | $14.13 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $40.74 / $64.57
| Professional | TC | $21.38 | $40.74 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $26.30 / $52.48
| Facility | 26 | $21.38 | $26.30 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $70.79
| Professional | | $42.66 | $42.66 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $18.62
| Professional | 26 | $11.22 | $11.22 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $52.48
| Professional | TC | $31.62 | $31.62 | $52.48 |
- 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
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $54.95 / $186.21
| Professional | | $26.92 | $54.95 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $16.22 / $67.61
| Professional | 26 | $8.32 | $16.22 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Professional | 52 | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $33.88 / $147.91
| Professional | TC | $19.05 | $33.88 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $85.11 / $213.80
| Professional | | $31.62 | $85.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $63.10 / $85.11
| Professional | 26 | $9.33 | $63.10 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $85.11 / $147.91
| Professional | TC | $21.88 | $85.11 | $147.91 |