- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $77.62 / $218.78
| Facility | 26 | $54.95 | $77.62 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $162.18 / $478.63
| Professional | | $45.71 | $162.18 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $72.44 / $218.78
| Professional | 26 | $43.65 | $72.44 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $43.65 / $660.69 / $954.99
| Professional | 50 | $43.65 | $660.69 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $169.82 / $331.13
| Professional | TC | $83.18 | $169.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $169.82 / $234.42
| Professional | | $102.33 | $169.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $85.11
| Professional | 26 | $38.90 | $61.66 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $134.90 / $144.54
| Professional | TC | $109.65 | $134.90 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $251.19 / $426.58
| Professional | | $162.18 | $251.19 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $70.79 / $107.15
| Professional | 26 | $50.12 | $70.79 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $239.88 / $380.19 / $645.65
| Professional | 50 | $239.88 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $186.21 / $316.23
| Professional | TC | $102.33 | $186.21 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $91.20 / $162.18
| Professional | | $47.86 | $91.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $275.42 / $489.78
| Professional | | $134.90 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $72.44 / $128.82
| Professional | 26 | $41.69 | $72.44 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $190.55 / $363.08
| Professional | TC | $93.33 | $190.55 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $173.78 / $660.69
| Professional | | $131.83 | $173.78 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $63.10 / $165.96
| Professional | 26 | $46.77 | $63.10 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $109.65 / $660.69
| Professional | TC | $85.11 | $109.65 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $120.23 / $257.04
| Professional | | $48.98 | $120.23 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $234.42 / $416.87
| Professional | | $141.25 | $234.42 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $61.66 / $112.20
| Professional | 26 | $44.67 | $61.66 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $165.96 / $295.12
| Professional | TC | $91.20 | $165.96 | $295.12 |