- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $35.48 / $107.15
| Facility | 26 | $19.95 | $35.48 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $123.03 / $323.59
| Professional | | $79.43 | $123.03 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $81.28
| Professional | 26 | $19.95 | $26.92 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $100.00 / $257.04
| Professional | TC | $67.61 | $100.00 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $169.82 / $169.82
| Facility | 26 | $63.10 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $162.18 / $851.14
| Professional | | $104.71 | $162.18 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $36.31 / $218.78
| Professional | 26 | $23.44 | $36.31 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $134.90 / $691.83
| Professional | TC | $85.11 | $134.90 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $69.18
| Professional | 26 | $30.90 | $52.48 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $181.97 / $354.81
| Professional | | $102.33 | $181.97 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $39.81 / $75.86
| Professional | 26 | $22.39 | $39.81 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $147.91 / $281.84
| Professional | TC | $83.18 | $147.91 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $154.88 / $263.03
| Professional | | $34.67 | $154.88 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $213.80 / $426.58
| Professional | | $138.04 | $213.80 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $40.74 / $72.44
| Professional | 26 | $27.54 | $40.74 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $295.12
| Professional | TC | $109.65 | $162.18 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $54.95 / $56.23
| Professional | | $47.86 | $54.95 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $169.82 / $169.82
| Facility | 26 | $63.10 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $162.18 / $851.14
| Professional | | $104.71 | $162.18 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $36.31 / $218.78
| Professional | 26 | $23.44 | $36.31 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $134.90 / $691.83
| Professional | TC | $85.11 | $134.90 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $169.82 / $407.38
| Professional | | $117.49 | $169.82 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $37.15 / $83.18
| Professional | 26 | $26.30 | $37.15 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $134.90 / $302.00
| Professional | TC | $91.20 | $134.90 | $302.00 |