- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $51.29 / $51.29
| Facility | 26 | $37.15 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $302.00
| Professional | | $100.00 | $151.36 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $44.67 / $87.10
| Professional | 26 | $34.67 | $44.67 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $83.18 / $138.04
| Professional | TC | $53.70 | $83.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $204.17 / $316.23
| Professional | | $128.82 | $204.17 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $52.48 / $81.28
| Professional | 26 | $38.90 | $52.48 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $218.78 / $316.23 / $478.63
| Professional | 50 | $218.78 | $316.23 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $151.36 / $239.88
| Professional | TC | $81.28 | $151.36 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $162.18 / $537.03
| Professional | | $89.13 | $162.18 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $40.74 / $50.12
| Professional | 26 | $36.31 | $40.74 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $120.23 / $151.36
| Professional | TC | $87.10 | $120.23 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Facility | 26 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $162.18 / $263.03
| Professional | | $104.71 | $162.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $54.95 / $87.10
| Professional | 26 | $38.90 | $54.95 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $109.65 / $181.97
| Professional | TC | $60.26 | $109.65 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $190.55 / $234.42
| Professional | | $158.49 | $190.55 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $48.98 / $61.66
| Professional | 26 | $38.90 | $48.98 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $144.54 / $177.83
| Professional | TC | $117.49 | $144.54 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $173.78 / $218.78
| Professional | | $141.25 | $173.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $64.57 / $75.86
| Professional | 26 | $52.48 | $64.57 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Professional | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $128.82 / $316.23
| Professional | | $52.48 | $128.82 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $58.88 / $93.33
| Professional | 26 | $41.69 | $58.88 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $114.82 / $169.82
| Professional | TC | $75.86 | $114.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $223.87
| Professional | | $89.13 | $138.04 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $85.11
| Professional | 26 | $33.88 | $51.29 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $83.18 / $141.25
| Professional | TC | $56.23 | $83.18 | $141.25 |