- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $87.10 / $87.10
| Facility | 26 | $16.98 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $61.66 / $229.09
| Professional | | $43.65 | $61.66 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $19.05 / $54.95
| Professional | 26 | $11.75 | $19.05 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $44.67 / $89.13
| Professional | TC | $33.11 | $44.67 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $66.07 / $104.71
| Professional | | $48.98 | $66.07 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $19.95 / $30.20
| Professional | 26 | $13.49 | $19.95 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $44.67 / $75.86
| Professional | TC | $34.67 | $44.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $33.11 / $89.13
| Professional | | $26.92 | $33.11 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | 26 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $85.11 / $104.71
| Professional | | $72.44 | $85.11 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $20.42 / $36.31
| Professional | 26 | $17.38 | $20.42 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $72.44
| Professional | TC | $54.95 | $64.57 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $104.71
| Professional | | $50.12 | $79.43 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $19.95 / $30.20
| Professional | 26 | $12.30 | $19.95 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $58.88 / $69.18
| Professional | TC | $38.02 | $58.88 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $54.95 / $97.72
| Professional | | $18.20 | $54.95 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $51.29 / $89.13
| Professional | | $46.77 | $51.29 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.49 / $25.70
| Professional | 26 | $12.02 | $15.49 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $35.48 / $61.66
| Professional | TC | $33.11 | $35.48 | $61.66 |