- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $29.51 / $70.79
| Facility | 26 | $15.85 | $29.51 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $104.71 / $181.97
| Professional | | $67.61 | $104.71 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $26.30 / $56.23
| Professional | 26 | $15.14 | $26.30 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $87.10 / $144.54
| Professional | TC | $60.26 | $87.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $123.03 / $190.55
| Professional | | $89.13 | $123.03 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $22.39 / $34.67
| Professional | 26 | $16.22 | $22.39 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $102.33 / $158.49
| Professional | TC | $72.44 | $102.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $100.00 / $295.12
| Professional | | $21.38 | $100.00 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $19.05 / $23.99
| Professional | 26 | $17.38 | $19.05 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $102.33 / $141.25
| Professional | TC | $77.62 | $102.33 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Facility | 26 | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $114.82 / $204.17
| Professional | | $75.86 | $114.82 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $21.38 / $36.31
| Professional | 26 | $14.13 | $21.38 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $165.96
| Professional | TC | $60.26 | $89.13 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $117.49 / $151.36
| Professional | | $97.72 | $117.49 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $20.42 / $25.70
| Professional | 26 | $16.22 | $20.42 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $97.72 / $125.89
| Professional | TC | $79.43 | $97.72 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $199.53 / $223.87
| Professional | | $162.18 | $199.53 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $33.11 / $38.02
| Professional | 26 | $26.30 | $33.11 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $165.96
| Professional | | $72.44 | $72.44 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $104.71 / $223.87
| Professional | | $21.88 | $104.71 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $23.44 / $40.74
| Professional | 26 | $17.78 | $23.44 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $112.20 / $181.97
| Professional | TC | $69.18 | $112.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $107.15 / $194.98
| Professional | | $72.44 | $107.15 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $21.38 / $38.90
| Professional | 26 | $13.80 | $21.38 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $85.11 / $158.49
| Professional | TC | $56.23 | $85.11 | $158.49 |