- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $117.49
| Facility | 26 | $28.18 | $40.74 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $50.12 / $223.87
| Professional | | $34.67 | $50.12 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $17.78 / $34.67
| Professional | 26 | $10.96 | $17.78 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $74.13
| Professional | TC | $22.91 | $28.84 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $32.36
| Professional | 26 | $25.70 | $25.70 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $79.43 / $83.18
| Professional | | $72.44 | $79.43 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $25.70 / $26.92
| Professional | 26 | $24.55 | $25.70 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $53.70 / $56.23
| Professional | TC | $48.98 | $53.70 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Facility | 26 | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $91.20 / $128.82
| Professional | | $33.88 | $91.20 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $30.90 / $39.81
| Professional | 26 | $16.22 | $30.90 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $61.66 / $91.20
| Professional | TC | $27.54 | $61.66 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $66.07 / $281.84
| Professional | | $44.67 | $66.07 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $100.00
| Professional | 26 | $15.85 | $23.99 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $41.69 / $251.19
| Professional | TC | $30.90 | $41.69 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $93.33 / $147.91
| Professional | | $83.18 | $93.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $30.90 / $46.77
| Professional | 26 | $26.92 | $30.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $63.10 / $102.33
| Professional | TC | $56.23 | $63.10 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Facility | 26 | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $83.18 / $147.91
| Professional | | $72.44 | $83.18 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $25.70 / $46.77
| Professional | 26 | $21.88 | $25.70 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $56.23 / $102.33
| Professional | TC | $51.29 | $56.23 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $30.20 / $72.44
| Professional | | $13.80 | $30.20 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $74.13 / $100.00
| Professional | | $44.67 | $74.13 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $25.12 / $38.02
| Professional | 26 | $15.49 | $25.12 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $42.66 / $64.57
| Professional | TC | $28.18 | $42.66 | $64.57 |