- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $29.51 / $54.95
| Facility | 26 | $16.98 | $29.51 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $120.23 / $281.84
| Professional | | $77.62 | $120.23 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $54.95
| Professional | 26 | $10.96 | $15.14 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $102.33 / $223.87
| Professional | TC | $66.07 | $102.33 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $16.22
| Professional | 26 | $9.33 | $9.33 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $186.21 / $363.08
| Professional | | $104.71 | $186.21 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $17.38 / $32.36
| Professional | 26 | $12.02 | $17.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $144.54 / $288.40
| Professional | TC | $91.20 | $144.54 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $186.21 / $338.84
| Professional | | $100.00 | $186.21 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $16.98 / $31.62
| Professional | 26 | $10.23 | $16.98 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $154.88 / $281.84
| Professional | TC | $85.11 | $154.88 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $131.83 / $416.87
| Professional | | $100.00 | $131.83 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $14.79 / $41.69
| Professional | 26 | $11.48 | $14.79 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $114.82 / $416.87
| Professional | TC | $89.13 | $114.82 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $316.23 / $389.05
| Professional | | $275.42 | $316.23 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $147.91 / $275.42
| Professional | | $102.33 | $147.91 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $14.13 / $26.92
| Professional | 26 | $10.72 | $14.13 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $131.83 / $251.19
| Professional | TC | $91.20 | $131.83 | $251.19 |