- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $33.11 / $38.90
| Facility | 26 | $20.89 | $33.11 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $60.26 / $257.04
| Professional | | $41.69 | $60.26 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $23.99 / $43.65
| Professional | 26 | $12.88 | $23.99 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $43.65 / $87.10
| Professional | TC | $28.84 | $43.65 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.80 / $17.38 / $25.12
| Facility | 26 | $3.80 | $17.38 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $100.00 / $147.91
| Professional | | $52.48 | $100.00 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $28.84 / $44.67
| Professional | 26 | $16.60 | $28.84 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $70.79 / $107.15
| Professional | TC | $37.15 | $70.79 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $114.82 / $141.25
| Professional | | $102.33 | $114.82 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $33.11 / $39.81
| Professional | 26 | $28.84 | $33.11 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $81.28 / $102.33
| Professional | TC | $72.44 | $81.28 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $30.90 / $38.90
| Facility | 26 | $20.89 | $30.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $100.00 / $158.49
| Professional | | $61.66 | $100.00 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $30.90 / $45.71
| Professional | 26 | $15.85 | $30.90 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $74.13 / $109.65
| Professional | TC | $42.66 | $74.13 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $35.48 / $70.79
| Professional | | $22.39 | $35.48 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $104.71 / $151.36
| Professional | | $81.28 | $104.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $31.62 / $44.67
| Professional | 26 | $20.89 | $31.62 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $109.65
| Professional | TC | $47.86 | $72.44 | $109.65 |
- 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
- $91.20 / $112.20 / $151.36
| Professional | | $91.20 | $112.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $33.11 / $43.65
| Professional | 26 | $27.54 | $33.11 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $79.43 / $107.15
| Professional | TC | $61.66 | $79.43 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $67.61 / $141.25
| Professional | | $47.86 | $67.61 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $43.65
| Professional | 26 | $15.14 | $19.05 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $97.72
| Professional | TC | $30.90 | $45.71 | $97.72 |