- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $32.36 / $102.33
| Facility | 26 | $19.95 | $32.36 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $120.23 / $338.84
| Professional | | $75.86 | $120.23 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $60.26 / $199.53
| Professional | 26 | $22.91 | $60.26 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $85.11 / $234.42
| Professional | TC | $56.23 | $85.11 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $72.44 / $213.80
| Facility | 26 | $37.15 | $72.44 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $154.88 / $602.56
| Professional | | $74.13 | $154.88 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $44.67 / $138.04
| Professional | 26 | $23.44 | $44.67 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $120.23 / $467.74
| Professional | TC | $25.70 | $120.23 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $275.42 / $363.08
| Professional | | $158.49 | $275.42 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $61.66 / $85.11
| Professional | 26 | $38.02 | $61.66 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $208.93 / $275.42
| Professional | TC | $123.03 | $208.93 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $117.49 / $239.88
| Professional | | $64.57 | $117.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $30.20 / $70.79
| Professional | 26 | $15.85 | $30.20 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $89.13 / $190.55
| Professional | TC | $47.86 | $89.13 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $134.90 / $218.78
| Professional | | $39.81 | $134.90 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $186.21 / $331.13
| Professional | | $131.83 | $186.21 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $83.18
| Professional | 26 | $32.36 | $45.71 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $190.55 / $263.03
| Professional | TC | $97.72 | $190.55 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $239.88 / $245.47
| Professional | | $54.95 | $239.88 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $72.44 / $213.80
| Facility | 26 | $37.15 | $72.44 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $154.88 / $602.56
| Professional | | $74.13 | $154.88 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $44.67 / $138.04
| Professional | 26 | $23.44 | $44.67 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $120.23 / $467.74
| Professional | TC | $25.70 | $120.23 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $162.18 / $354.81
| Professional | | $83.18 | $162.18 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $41.69 / $89.13
| Professional | 26 | $20.42 | $41.69 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $123.03 / $288.40
| Professional | TC | $60.26 | $123.03 | $288.40 |