- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $22.39
| Facility | 26 | $12.88 | $12.88 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $57.54 / $158.49
| Professional | | $34.67 | $57.54 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $19.05 / $45.71
| Professional | 26 | $10.96 | $19.05 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Professional | 52 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $33.11 / $77.62
| Professional | TC | $23.99 | $33.11 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $10.96 / $10.96
| Facility | 26 | $9.12 | $10.96 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $114.82 / $162.18
| Professional | | $74.13 | $114.82 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $46.77
| Professional | 26 | $21.88 | $32.36 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $87.10 / $117.49
| Professional | TC | $53.70 | $87.10 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $46.77 / $114.82
| Facility | 26 | $19.95 | $46.77 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $87.10 / $141.25
| Professional | | $45.71 | $87.10 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $24.55 / $39.81
| Professional | 26 | $15.14 | $24.55 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $61.66 / $100.00
| Professional | TC | $28.84 | $61.66 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $45.71 / $89.13
| Facility | 26 | $36.31 | $45.71 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $114.82
| Professional | | $69.18 | $69.18 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $31.62
| Professional | 26 | $19.50 | $19.50 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $83.18
| Professional | TC | $50.12 | $50.12 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $89.13 / $288.40
| Professional | | $42.66 | $89.13 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $26.92 / $83.18
| Professional | 26 | $14.13 | $26.92 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $40.74 / $208.93
| Professional | TC | $25.70 | $40.74 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $85.11 / $331.13
| Professional | | $46.77 | $85.11 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $85.11 / $104.71
| Professional | 26 | $16.60 | $85.11 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $85.11 / $229.09
| Professional | TC | $30.90 | $85.11 | $229.09 |