- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $22.39 / $31.62
| Facility | 26 | $17.38 | $22.39 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $61.66 / $194.98
| Professional | | $38.02 | $61.66 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.98 / $34.67
| Professional | 26 | $10.00 | $16.98 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $37.15 / $83.18
| Professional | TC | $25.70 | $37.15 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $14.13 / $20.42
| Facility | 26 | $3.02 | $14.13 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $87.10 / $131.83
| Professional | | $45.71 | $87.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $23.44 / $35.48
| Professional | 26 | $13.18 | $23.44 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $63.10 / $97.72
| Professional | TC | $32.36 | $63.10 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $104.71 / $125.89
| Professional | | $93.33 | $104.71 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $27.54 / $31.62
| Professional | 26 | $23.99 | $27.54 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $77.62 / $95.50
| Professional | TC | $69.18 | $77.62 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $22.39 / $31.62
| Facility | 26 | $17.38 | $22.39 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $91.20 / $141.25
| Professional | | $53.70 | $91.20 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $25.12 / $37.15
| Professional | 26 | $14.13 | $25.12 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $70.79 / $102.33
| Professional | TC | $38.02 | $70.79 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $34.67 / $67.61
| Professional | | $17.78 | $34.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $93.33 / $134.90
| Professional | | $70.79 | $93.33 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $25.70 / $36.31
| Professional | 26 | $16.98 | $25.70 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $100.00
| Professional | TC | $40.74 | $63.10 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | 26 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $100.00 / $134.90
| Professional | | $77.62 | $100.00 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $26.92 / $36.31
| Professional | 26 | $22.39 | $26.92 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $72.44 / $100.00
| Professional | TC | $54.95 | $72.44 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $56.23 / $128.82
| Professional | | $41.69 | $56.23 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $15.85 / $35.48
| Professional | 26 | $12.30 | $15.85 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $93.33
| Professional | TC | $28.18 | $40.74 | $93.33 |