- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $97.72
| Facility | 26 | $22.91 | $32.36 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $46.77 / $239.88
| Professional | | $38.02 | $46.77 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $14.45 / $29.51
| Professional | 26 | $10.00 | $14.45 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $34.67 / $177.83
| Professional | TC | $26.92 | $34.67 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $79.43 / $85.11
| Professional | | $74.13 | $79.43 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $21.88 / $22.91
| Professional | 26 | $20.89 | $21.88 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $58.88 / $61.66
| Professional | TC | $53.70 | $58.88 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | 26 | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $91.20 / $131.83
| Professional | | $34.67 | $91.20 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $25.70 / $33.88
| Professional | 26 | $13.49 | $25.70 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $66.07 / $100.00
| Professional | TC | $30.20 | $66.07 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | 26 | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $70.79 / $288.40
| Professional | | $47.86 | $70.79 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $19.50 / $107.15
| Professional | 26 | $13.18 | $19.50 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $269.15
| Professional | TC | $33.88 | $46.77 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $95.50 / $151.36
| Professional | | $85.11 | $95.50 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $25.70 / $39.81
| Professional | 26 | $22.91 | $25.70 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $69.18 / $112.20
| Professional | TC | $61.66 | $69.18 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | 26 | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $83.18 / $151.36
| Professional | | $79.43 | $83.18 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $20.89 / $39.81
| Professional | 26 | $18.20 | $20.89 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $112.20
| Professional | TC | $61.66 | $61.66 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $33.88 / $74.13
| Professional | | $11.75 | $33.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $74.13 / $100.00
| Professional | | $46.77 | $74.13 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $19.95 / $30.20
| Professional | 26 | $12.02 | $19.95 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $47.86 / $69.18
| Professional | TC | $33.11 | $47.86 | $69.18 |