- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $58.88 / $117.49
| Facility | 26 | $46.77 | $58.88 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $151.36 / $354.81
| Professional | | $89.13 | $151.36 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $67.61 / $154.88
| Professional | 26 | $41.69 | $67.61 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $43.65 / $91.20 / $309.03
| Professional | 52 | $43.65 | $91.20 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $91.20 / $186.21
| Professional | TC | $45.71 | $91.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $100.00 / $104.71
| Professional | | $61.66 | $100.00 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $43.65
| Professional | 26 | $38.90 | $38.90 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Professional | 52 | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $138.04 / $288.40
| Professional | | $114.82 | $138.04 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $61.66 / $102.33
| Professional | 26 | $52.48 | $61.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $75.86 / $186.21
| Professional | TC | $61.66 | $75.86 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $77.62 / $141.25
| Professional | | $63.10 | $77.62 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $48.98 / $70.79
| Facility | 26 | $10.47 | $48.98 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $223.87 / $467.74
| Professional | | $93.33 | $223.87 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $87.10 / $181.97
| Professional | 26 | $41.69 | $87.10 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $141.25 / $295.12
| Professional | TC | $52.48 | $141.25 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $158.49 / $213.80
| Professional | | $112.20 | $158.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $67.61 / $95.50
| Professional | 26 | $47.86 | $67.61 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $91.20 / $120.23
| Professional | TC | $64.57 | $91.20 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $199.53
| Professional | | $85.11 | $128.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $57.54 / $93.33
| Professional | 26 | $39.81 | $57.54 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $109.65
| Professional | TC | $45.71 | $70.79 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $47.86
| Professional | 26 | $32.36 | $32.36 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $117.49 / $117.49
| Professional | | $57.54 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $104.71 / $107.15
| Professional | 26 | $52.48 | $104.71 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $58.88
| Professional | 52 | $57.54 | $57.54 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $158.49 / $331.13
| Professional | | $134.90 | $158.49 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $61.66 / $128.82
| Professional | 26 | $51.29 | $61.66 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $97.72 / $177.83
| Professional | TC | $81.28 | $97.72 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $154.88 / $478.63
| Professional | | $102.33 | $154.88 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $61.66 / $173.78
| Professional | 26 | $40.74 | $61.66 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $87.10 / $295.12
| Professional | TC | $58.88 | $87.10 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $51.29 / $295.12
| Facility | 26 | $35.48 | $51.29 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $128.82 / $309.03
| Professional | | $77.62 | $128.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $57.54 / $123.03
| Professional | 26 | $35.48 | $57.54 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $67.61 / $177.83
| Professional | TC | $41.69 | $67.61 | $177.83 |