- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $24.55 / $95.50
| Facility | 26 | $18.20 | $24.55 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $91.20 / $275.42
| Professional | | $37.15 | $91.20 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $50.12 / $128.82
| Professional | 26 | $19.95 | $50.12 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $24.55 / $91.20
| Professional | TC | $16.98 | $24.55 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $57.54 / $151.36
| Facility | 26 | $26.30 | $57.54 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $75.86 / $524.81
| Professional | | $38.90 | $75.86 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $31.62 / $151.36
| Professional | 26 | $19.95 | $31.62 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $35.48 / $380.19
| Professional | TC | $19.95 | $35.48 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $89.13 / $125.89
| Professional | | $54.95 | $89.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $44.67 / $61.66
| Professional | 26 | $26.92 | $44.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $72.44 / $141.25
| Professional | | $38.02 | $72.44 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $34.67 / $66.07
| Professional | 26 | $19.05 | $34.67 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $35.48 / $74.13
| Professional | TC | $17.78 | $35.48 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $77.62
| Professional | | $25.12 | $38.90 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $81.28 / $128.82
| Professional | | $30.20 | $81.28 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $39.81 / $64.57
| Professional | 26 | $24.55 | $39.81 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $58.88
| Professional | TC | $25.70 | $38.90 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $389.05
| Professional | | $40.74 | $63.10 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $57.54 / $151.36
| Facility | 26 | $26.30 | $57.54 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $75.86 / $524.81
| Professional | | $38.90 | $75.86 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $31.62 / $151.36
| Professional | 26 | $19.95 | $31.62 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $35.48 / $380.19
| Professional | TC | $19.95 | $35.48 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $77.62 / $138.04
| Professional | | $45.71 | $77.62 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $33.88 / $75.86
| Professional | 26 | $23.44 | $33.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $67.61
| Professional | TC | $21.88 | $36.31 | $67.61 |