- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $47.86 / $58.88
| Facility | 26 | $44.67 | $47.86 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $47.86 / $134.90
| Professional | | $28.18 | $47.86 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $15.85 / $40.74
| Professional | 26 | $10.00 | $15.85 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $31.62 / $83.18
| Professional | TC | $18.20 | $31.62 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $67.61 / $131.83
| Professional | | $48.98 | $67.61 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $22.91 / $47.86
| Professional | 26 | $14.45 | $22.91 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $42.66 / $83.18
| Professional | TC | $33.88 | $42.66 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $47.86 / $58.88
| Facility | 26 | $44.67 | $47.86 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $114.82 / $275.42
| Professional | | $46.77 | $114.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $39.81 / $100.00
| Professional | 26 | $15.49 | $39.81 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $77.62 / $138.04
| Professional | TC | $31.62 | $77.62 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $177.83 / $257.04
| Professional | | $158.49 | $177.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $54.95 / $93.33
| Professional | 26 | $50.12 | $54.95 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $123.03 / $173.78
| Professional | TC | $87.10 | $123.03 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $109.65 / $131.83
| Professional | | $51.29 | $109.65 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $19.95 / $52.48
| Professional | 26 | $11.75 | $19.95 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $35.48 / $83.18
| Professional | TC | $24.55 | $35.48 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $104.71 / $223.87
| Professional | | $51.29 | $104.71 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $41.69 / $89.13
| Professional | 26 | $15.49 | $41.69 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $63.10 / $131.83
| Professional | TC | $35.48 | $63.10 | $131.83 |