- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $37.15 / $109.65
| Facility | 26 | $26.30 | $37.15 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $208.93 / $501.19
| Professional | | $102.33 | $208.93 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $57.54 / $128.82
| Professional | 26 | $29.51 | $57.54 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $48.98 / $134.90 / $275.42
| Professional | 52 | $48.98 | $134.90 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $102.33 / $245.47
| Professional | TC | $70.79 | $102.33 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $97.72 / $131.83
| Professional | | $83.18 | $97.72 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $28.84 / $48.98
| Professional | 26 | $25.12 | $28.84 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $83.18 / $125.89
| Professional | TC | $64.57 | $83.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $125.89 / $257.04
| Professional | | $102.33 | $125.89 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $33.11 / $66.07
| Professional | 26 | $26.92 | $33.11 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $91.20 / $169.82
| Professional | TC | $75.86 | $91.20 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $125.89 / $173.78
| Professional | | $47.86 | $125.89 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $37.15 / $53.70
| Facility | 26 | $7.94 | $37.15 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $169.82 / $398.11
| Professional | | $100.00 | $169.82 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $48.98 / $114.82
| Professional | 26 | $26.92 | $48.98 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $120.23 / $346.74
| Professional | TC | $67.61 | $120.23 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $151.36 / $245.47
| Professional | | $120.23 | $151.36 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $48.98 / $109.65
| Professional | 26 | $33.11 | $48.98 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $117.49 / $186.21
| Professional | TC | $89.13 | $117.49 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $151.36 / $269.15
| Professional | | $72.44 | $151.36 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $44.67 / $83.18
| Professional | 26 | $26.92 | $44.67 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $109.65 / $194.98
| Professional | TC | $43.65 | $109.65 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $30.20 / $47.86
| Professional | 26 | $14.79 | $30.20 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | TC | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $245.47
| Professional | | $134.90 | $134.90 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $39.81 / $69.18
| Professional | 26 | $38.90 | $39.81 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | 52 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $97.72 / $169.82
| Professional | TC | $95.50 | $97.72 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $169.82 / $263.03
| Professional | | $141.25 | $169.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $47.86 / $74.13
| Professional | 26 | $38.90 | $47.86 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $120.23 / $190.55
| Professional | TC | $102.33 | $120.23 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $169.82 / $354.81
| Professional | | $100.00 | $169.82 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $42.66 / $245.47
| Professional | 26 | $27.54 | $42.66 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $354.81
| Professional | TC | $74.13 | $117.49 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $38.02 / $112.20
| Facility | 26 | $26.92 | $38.02 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $151.36 / $302.00
| Professional | | $85.11 | $151.36 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $43.65 / $107.15
| Professional | 26 | $26.92 | $43.65 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $109.65 / $223.87
| Professional | TC | $66.07 | $109.65 | $223.87 |