- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $24.55 / $93.33
| Facility | 26 | $18.20 | $24.55 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $91.20 / $316.23
| Professional | | $38.90 | $91.20 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $39.81 / $77.62
| Professional | 26 | $19.05 | $39.81 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $36.31 / $97.72
| Professional | TC | $18.20 | $36.31 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $147.91 / $147.91
| Facility | 26 | $54.95 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $83.18 / $588.84
| Professional | | $44.67 | $83.18 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $30.20 / $239.88
| Professional | 26 | $17.38 | $30.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $54.95 / $416.87
| Professional | TC | $23.99 | $54.95 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $107.15 / $162.18
| Professional | | $61.66 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $45.71 / $61.66
| Professional | 26 | $26.92 | $45.71 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $85.11 / $186.21
| Professional | | $39.81 | $85.11 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $31.62 / $64.57
| Professional | 26 | $17.78 | $31.62 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $46.77 / $120.23
| Professional | TC | $21.88 | $46.77 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $43.65 / $93.33
| Professional | | $27.54 | $43.65 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $77.62 / $141.25
| Professional | | $52.48 | $77.62 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $36.31 / $63.10
| Professional | 26 | $24.55 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $75.86
| Professional | TC | $28.18 | $44.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $44.67 / $87.10
| Professional | | $36.31 | $44.67 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $147.91 / $147.91
| Facility | 26 | $54.95 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $83.18 / $588.84
| Professional | | $44.67 | $83.18 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $30.20 / $239.88
| Professional | 26 | $17.38 | $30.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $54.95 / $416.87
| Professional | TC | $23.99 | $54.95 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $85.11 / $112.20
| Professional | | $43.65 | $85.11 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $87.10 / $158.49
| Professional | | $50.12 | $87.10 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $74.13
| Professional | 26 | $19.05 | $32.36 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $53.70 / $91.20
| Professional | TC | $25.12 | $53.70 | $91.20 |