- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $74.13
| Facility | 26 | $36.31 | $36.31 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $91.20 / $223.87
| Professional | | $61.66 | $91.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $47.86 / $120.23
| Professional | 26 | $33.11 | $47.86 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $41.69 / $81.28
| Professional | TC | $19.95 | $41.69 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $85.11 / $234.42
| Facility | 26 | $28.84 | $85.11 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $562.34
| Professional | | $64.57 | $107.15 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $56.23 / $245.47
| Professional | 26 | $35.48 | $56.23 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $54.95 / $288.40
| Professional | TC | $30.90 | $54.95 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $154.88 / $467.74
| Professional | | $93.33 | $154.88 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $60.26 / $131.83
| Professional | 26 | $35.48 | $60.26 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $114.82 / $309.03
| Professional | TC | $52.48 | $114.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $117.49 / $288.40
| Professional | | $75.86 | $117.49 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $61.66 / $128.82
| Professional | 26 | $39.81 | $61.66 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $64.57 / $138.04
| Professional | TC | $28.84 | $64.57 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $50.12 / $109.65
| Professional | | $23.44 | $50.12 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $138.04 / $218.78
| Professional | | $50.12 | $138.04 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $64.57 / $102.33
| Professional | 26 | $38.02 | $64.57 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $85.11 / $128.82
| Professional | TC | $42.66 | $85.11 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $67.61 / $309.03
| Professional | | $53.70 | $67.61 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $85.11 / $234.42
| Facility | 26 | $28.84 | $85.11 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $562.34
| Professional | | $64.57 | $107.15 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $56.23 / $245.47
| Professional | 26 | $35.48 | $56.23 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $54.95 / $288.40
| Professional | TC | $30.90 | $54.95 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $109.65 / $234.42
| Professional | | $75.86 | $109.65 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $60.26 / $114.82
| Professional | 26 | $39.81 | $60.26 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $54.95 / $128.82
| Professional | TC | $30.90 | $54.95 | $128.82 |