- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | 26 | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $56.23 / $107.15
| Professional | | $33.11 | $56.23 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $38.90
| Professional | 26 | $12.02 | $15.85 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $36.31 / $66.07
| Professional | TC | $19.95 | $36.31 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | 26 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $104.71
| Professional | | $64.57 | $75.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $28.18 / $37.15
| Professional | 26 | $23.99 | $28.18 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $66.07
| Professional | TC | $39.81 | $46.77 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $64.57 / $97.72
| Professional | | $38.02 | $64.57 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $23.44 / $33.88
| Professional | 26 | $15.85 | $23.44 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $41.69 / $60.26
| Professional | TC | $22.91 | $41.69 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $208.93
| Professional | | $186.21 | $186.21 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $151.36
| Professional | 26 | $120.23 | $120.23 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $67.61 / $67.61
| Professional | TC | $57.54 | $67.61 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | 26 | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $79.43 / $117.49
| Professional | | $46.77 | $79.43 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $28.84 / $41.69
| Professional | 26 | $15.49 | $28.84 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $51.29 / $75.86
| Professional | TC | $29.51 | $51.29 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $31.62 / $33.11
| Professional | | $12.02 | $31.62 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | 26 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $102.33
| Professional | | $67.61 | $85.11 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $30.90 / $37.15
| Professional | 26 | $24.55 | $30.90 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $53.70 / $64.57
| Professional | TC | $43.65 | $53.70 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $39.81 / $144.54
| Professional | | $38.90 | $39.81 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $33.11
| Professional | 26 | $14.45 | $14.45 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $54.95
| Professional | TC | $24.55 | $28.84 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $51.29 / $87.10
| Professional | | $40.74 | $51.29 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $16.60 / $31.62
| Professional | 26 | $15.49 | $16.60 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $36.31 / $60.26
| Professional | TC | $24.55 | $36.31 | $60.26 |