- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $32.36
| Facility | 26 | $15.85 | $19.95 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $91.20
| Professional | | $38.02 | $54.95 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $21.88 / $38.90
| Professional | 26 | $16.22 | $21.88 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $33.11 / $50.12
| Professional | TC | $18.20 | $33.11 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $51.29 / $64.57
| Professional | | $45.71 | $51.29 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $19.50 / $29.51
| Professional | 26 | $16.60 | $19.50 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $39.81 / $70.79
| Professional | | $16.22 | $39.81 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $87.10 / $87.10
| Professional | | $58.88 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.95
| Professional | 26 | $19.05 | $19.05 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $61.66 / $107.15
| Professional | | $43.65 | $61.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $47.86
| Professional | 26 | $20.42 | $28.18 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $63.10
| Professional | TC | $19.05 | $32.36 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | 26 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $457.09 / $457.09
| Professional | | $380.19 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $162.18 / $162.18
| Professional | 26 | $138.04 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $302.00 / $302.00
| Professional | TC | $239.88 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $32.36
| Facility | 26 | $15.85 | $19.95 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $60.26 / $100.00
| Professional | | $38.02 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $22.91 / $38.90
| Professional | 26 | $16.98 | $22.91 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $37.15 / $63.10
| Professional | TC | $18.20 | $37.15 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $32.36 / $44.67
| Professional | | $16.98 | $32.36 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $56.23 / $109.65
| Professional | | $21.38 | $56.23 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $61.66 / $109.65
| Professional | | $43.65 | $61.66 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $42.66
| Professional | 26 | $19.95 | $27.54 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $54.95
| Professional | TC | $19.05 | $32.36 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $47.86 / $77.62
| Professional | | $33.88 | $47.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $23.44 / $37.15
| Professional | 26 | $17.38 | $23.44 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $25.12 / $41.69
| Professional | TC | $15.14 | $25.12 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $54.95 / $66.07
| Professional | | $53.70 | $54.95 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $20.42 / $24.55
| Professional | 26 | $19.50 | $20.42 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $35.48 / $41.69
| Professional | TC | $33.88 | $35.48 | $41.69 |