- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $31.62 / $38.90
| Facility | 26 | $30.90 | $31.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $436.52
| Professional | | $85.11 | $128.82 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $35.48 / $100.00
| Professional | 26 | $22.91 | $35.48 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $89.13 / $204.17
| Professional | TC | $61.66 | $89.13 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $89.13 / $204.17
| Professional | | $72.44 | $89.13 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $25.70 / $42.66
| Professional | 26 | $20.89 | $25.70 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $158.49 / $169.82
| Professional | | $120.23 | $158.49 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Professional | 26 | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $128.82 / $128.82
| Professional | TC | $109.65 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $93.33 / $131.83
| Professional | | $26.30 | $93.33 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $125.89 / $263.03
| Professional | | $83.18 | $125.89 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $33.11 / $67.61
| Professional | 26 | $20.89 | $33.11 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $223.87
| Professional | TC | $60.26 | $89.13 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $57.54
| Facility | 26 | $30.90 | $30.90 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $123.03 / $269.15
| Professional | | $81.28 | $123.03 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $32.36 / $67.61
| Professional | 26 | $22.39 | $32.36 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $89.13 / $177.83
| Professional | TC | $56.23 | $89.13 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $114.82 / $177.83
| Professional | | $83.18 | $114.82 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $30.90 / $47.86
| Professional | 26 | $20.89 | $30.90 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $85.11 / $141.25
| Professional | TC | $58.88 | $85.11 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $114.82 / $223.87
| Professional | | $85.11 | $114.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $33.11 / $158.49
| Professional | 26 | $25.70 | $33.11 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $87.10 / $134.90
| Professional | TC | $57.54 | $87.10 | $134.90 |