- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $37.15 / $109.65
| Facility | 26 | $15.14 | $37.15 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $75.86 / $257.04
| Professional | | $56.23 | $75.86 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $16.60 / $50.12
| Professional | 26 | $14.13 | $16.60 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $95.50
| Professional | TC | $39.81 | $56.23 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $81.28 / $177.83
| Professional | | $19.50 | $81.28 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $18.20 / $18.20
| Professional | 26 | $16.22 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $72.44 / $87.10
| Professional | TC | $64.57 | $72.44 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $89.13 / $194.98
| Professional | | $64.57 | $89.13 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $20.89 / $42.66
| Professional | 26 | $14.45 | $20.89 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $67.61 / $154.88
| Professional | TC | $47.86 | $67.61 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $93.33 / $190.55
| Professional | | $79.43 | $93.33 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $18.62 / $38.02
| Professional | 26 | $15.85 | $18.62 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $74.13 / $151.36
| Professional | TC | $63.10 | $74.13 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $407.38
| Professional | | $61.66 | $95.50 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $46.77 / $104.71
| Professional | 26 | $15.14 | $46.77 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $89.13 / $302.00
| Professional | TC | $43.65 | $89.13 | $302.00 |