- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $100.00
| Facility | 26 | $60.26 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $53.70 / $74.13
| Professional | | $42.66 | $53.70 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $19.95 / $25.70
| Professional | 26 | $14.13 | $19.95 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $33.88 / $45.71
| Professional | TC | $28.84 | $33.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $91.20 / $117.49
| Professional | | $64.57 | $91.20 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $34.67 / $44.67
| Professional | 26 | $24.55 | $34.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $72.44
| Professional | TC | $39.81 | $56.23 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $48.98 / $102.33
| Professional | | $28.84 | $48.98 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $16.22 / $34.67
| Professional | 26 | $10.47 | $16.22 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $30.90 / $66.07
| Professional | TC | $18.62 | $30.90 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $64.57 / $97.72
| Professional | | $47.86 | $64.57 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $22.91 / $34.67
| Professional | 26 | $17.38 | $22.91 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $41.69 / $63.10
| Professional | TC | $30.20 | $41.69 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $69.18 / $109.65
| Professional | | $57.54 | $69.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $40.74
| Professional | 26 | $20.89 | $26.92 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $42.66 / $69.18
| Professional | TC | $36.31 | $42.66 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $53.70 / $79.43
| Professional | | $46.77 | $53.70 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $19.95 / $28.84
| Professional | 26 | $12.02 | $19.95 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $50.12
| Professional | TC | $30.90 | $33.88 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $112.20 / $239.88
| Professional | | $95.50 | $112.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $63.10 / $131.83
| Professional | | $9.77 | $63.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $24.55 / $25.12
| Professional | 26 | $22.91 | $24.55 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $40.74 / $45.71
| Professional | TC | $39.81 | $40.74 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $67.61 / $109.65
| Professional | | $39.81 | $67.61 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $25.70 / $42.66
| Professional | 26 | $14.13 | $25.70 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $44.67 / $70.79
| Professional | TC | $24.55 | $44.67 | $70.79 |