- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $22.39 / $27.54
| Facility | 26 | $15.85 | $22.39 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $60.26 / $204.17
| Professional | | $33.11 | $60.26 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $17.78 / $42.66
| Professional | 26 | $8.91 | $17.78 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $38.02 / $70.79
| Professional | TC | $23.99 | $38.02 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $208.93
| Professional | | $38.90 | $61.66 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $16.60 / $58.88
| Professional | 26 | $10.47 | $16.60 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $44.67 / $154.88
| Professional | TC | $28.84 | $44.67 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $35.48 / $50.12
| Professional | | $13.49 | $35.48 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $32.36 / $52.48
| Facility | 26 | $28.18 | $32.36 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $109.65 / $165.96
| Professional | | $46.77 | $109.65 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $28.18 / $43.65
| Professional | 26 | $12.30 | $28.18 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $81.28 / $120.23
| Professional | TC | $33.88 | $81.28 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $89.13 / $123.03
| Professional | | $74.13 | $89.13 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $23.99 / $32.36
| Professional | 26 | $19.95 | $23.99 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $66.07 / $91.20
| Professional | TC | $54.95 | $66.07 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $338.84
| Facility | 26 | $100.00 | $100.00 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $81.28 / $263.03
| Professional | | $42.66 | $81.28 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $23.99 / $117.49
| Professional | 26 | $11.75 | $23.99 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $61.66 / $199.53
| Professional | TC | $30.90 | $61.66 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $87.10 / $162.18
| Professional | | $51.29 | $87.10 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $25.12 / $40.74
| Professional | 26 | $14.45 | $25.12 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $63.10 / $117.49
| Professional | TC | $39.81 | $63.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $107.15 / $177.83
| Professional | | $56.23 | $107.15 | $177.83 |
- 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
- $58.88 / $190.55 / $263.03
| Professional | | $58.88 | $190.55 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $56.23 / $117.49
| Professional | 26 | $15.49 | $56.23 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $134.90 / $208.93
| Professional | TC | $42.66 | $134.90 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Professional | 26 | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Professional | TC | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $218.78 / $257.04
| Professional | | $87.10 | $218.78 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $31.62 / $64.57
| Professional | 26 | $24.55 | $31.62 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $75.86 / $173.78
| Professional | TC | $61.66 | $75.86 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $138.04 / $302.00
| Professional | | $67.61 | $138.04 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $70.79 / $95.50
| Professional | 26 | $19.95 | $70.79 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $95.50 / $213.80
| Professional | TC | $53.70 | $95.50 | $213.80 |