- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $15.14 / $25.70
| Facility | 26 | $14.79 | $15.14 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $52.48 / $125.89
| Professional | | $34.67 | $52.48 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $15.49 / $37.15
| Professional | 26 | $7.94 | $15.49 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $31.62 / $104.71
| Professional | TC | $22.91 | $31.62 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $12.88 / $12.88
| Facility | 26 | $10.72 | $12.88 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $107.15 / $154.88
| Professional | | $70.79 | $107.15 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $37.15 / $53.70
| Professional | 26 | $24.55 | $37.15 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $74.13 / $100.00
| Professional | TC | $46.77 | $74.13 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $51.29 / $125.89
| Facility | 26 | $24.55 | $51.29 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $134.90
| Professional | | $61.66 | $83.18 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $27.54 / $43.65
| Professional | 26 | $11.48 | $27.54 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $54.95 / $97.72
| Professional | TC | $42.66 | $54.95 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $51.29 / $102.33
| Facility | 26 | $41.69 | $51.29 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $107.15
| Professional | | $64.57 | $64.57 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $36.31
| Professional | 26 | $21.88 | $21.88 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $72.44
| Professional | TC | $42.66 | $42.66 | $72.44 |
- 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
- $42.66 / $89.13 / $478.63
| Professional | | $42.66 | $89.13 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $24.55 / $213.80
| Professional | 26 | $10.96 | $24.55 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $63.10 / $426.58
| Professional | TC | $26.92 | $63.10 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $100.00 / $316.23
| Professional | | $50.12 | $100.00 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $81.28 / $117.49
| Professional | 26 | $14.13 | $81.28 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $58.88 / $95.50
| Professional | TC | $26.92 | $58.88 | $95.50 |