- 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
- $30.90 / $51.29 / $75.86
| Professional | | $30.90 | $51.29 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $20.89 / $30.90
| Professional | 26 | $16.98 | $20.89 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.00 / $30.20 / $44.67
| Professional | TC | $10.00 | $30.20 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $61.66 / $63.10
| Professional | | $50.12 | $61.66 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $23.99 / $25.70
| Professional | 26 | $19.95 | $23.99 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $40.74 / $72.44
| Professional | | $18.62 | $40.74 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $81.28 / $83.18
| Professional | | $44.67 | $81.28 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $19.95
| Professional | 26 | $19.50 | $19.50 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $54.95 / $100.00
| Professional | | $35.48 | $54.95 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $46.77
| Professional | 26 | $20.42 | $28.18 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $26.92 / $56.23
| Professional | TC | $11.22 | $26.92 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | 26 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $436.52 / $436.52
| Professional | | $354.81 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $165.96 / $165.96
| Professional | 26 | $131.83 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $269.15 / $269.15
| Professional | TC | $223.87 | $269.15 | $269.15 |
- 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
- $30.90 / $56.23 / $95.50
| Professional | | $30.90 | $56.23 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $37.15
| Professional | 26 | $16.98 | $21.88 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.23 / $33.88 / $57.54
| Professional | TC | $10.23 | $33.88 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $32.36 / $33.11
| Professional | | $20.42 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $50.12 / $104.71
| Professional | | $21.88 | $50.12 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $56.23 / $100.00
| Professional | | $36.31 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $26.92 / $42.66
| Professional | 26 | $20.42 | $26.92 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $26.92 / $48.98
| Professional | TC | $11.22 | $26.92 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $43.65 / $69.18
| Professional | | $28.18 | $43.65 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $23.44 / $36.31
| Professional | 26 | $17.38 | $23.44 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.12 / $19.50 / $37.15
| Professional | TC | $9.12 | $19.50 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $52.48 / $63.10
| Professional | | $50.12 | $52.48 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $20.42 / $25.12
| Professional | 26 | $19.95 | $20.42 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $31.62 / $38.02
| Professional | TC | $30.20 | $31.62 | $38.02 |