- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $79.43 / $123.03
| Facility | 26 | $58.88 | $79.43 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $213.80 / $707.95
| Professional | | $89.13 | $213.80 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $389.05
| Professional | 26 | $41.69 | $61.66 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $87.10 / $275.42 / $389.05
| Professional | 50 | $87.10 | $275.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $53.70 / $104.71
| Professional | TC | $39.81 | $53.70 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $147.91 / $223.87
| Professional | | $93.33 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $83.18 / $91.20
| Professional | 26 | $53.70 | $83.18 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $181.97 / $263.03
| Professional | | $131.83 | $181.97 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $85.11 / $123.03
| Professional | 26 | $60.26 | $85.11 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $97.72 / $138.04
| Professional | TC | $67.61 | $97.72 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $158.49 / $295.12
| Professional | | $89.13 | $158.49 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $74.13 / $131.83
| Professional | 26 | $44.67 | $74.13 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $83.18 / $162.18
| Professional | TC | $42.66 | $83.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $64.57 / $109.65
| Facility | 26 | $40.74 | $64.57 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $120.23 / $223.87
| Professional | | $79.43 | $120.23 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $60.26 / $104.71
| Professional | 26 | $38.02 | $60.26 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $64.57 / $131.83
| Professional | TC | $40.74 | $64.57 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.11 / $61.66
| Professional | | $28.18 | $33.11 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $97.72
| Professional | | $66.07 | $87.10 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Facility | 26 | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $181.97 / $269.15
| Professional | | $131.83 | $181.97 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $85.11 / $123.03
| Professional | 26 | $60.26 | $85.11 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $141.25
| Professional | TC | $70.79 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $177.83 / $239.88
| Professional | | $131.83 | $177.83 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $85.11 / $112.20
| Professional | 26 | $60.26 | $85.11 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $95.50 / $131.83
| Professional | TC | $67.61 | $95.50 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $263.03
| Professional | | $100.00 | $147.91 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $75.86 / $125.89
| Professional | 26 | $46.77 | $75.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $138.04
| Professional | TC | $54.95 | $75.86 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $117.49 / $223.87
| Professional | | $104.71 | $117.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $50.12 / $95.50
| Professional | 26 | $46.77 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $66.07 / $125.89
| Professional | TC | $57.54 | $66.07 | $125.89 |