- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $29.51 / $35.48
| Facility | 26 | $23.99 | $29.51 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $371.54
| Professional | | $114.82 | $151.36 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $74.13
| Professional | 26 | $20.89 | $30.20 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $112.20 / $251.19
| Professional | TC | $91.20 | $112.20 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $95.50 / $95.50
| Professional | | $91.20 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Professional | 26 | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $169.82 / $251.19
| Professional | | $123.03 | $169.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $43.65
| Professional | 26 | $22.91 | $28.84 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $141.25 / $208.93
| Professional | TC | $97.72 | $141.25 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $141.25 / $186.21
| Professional | | $120.23 | $141.25 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $27.54 / $37.15
| Professional | 26 | $23.99 | $27.54 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $114.82 / $151.36
| Professional | TC | $97.72 | $114.82 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $26.30 / $38.02
| Facility | 26 | $5.62 | $26.30 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $181.97 / $338.84
| Professional | | $120.23 | $181.97 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $63.10
| Professional | 26 | $21.88 | $30.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $154.88 / $281.84
| Professional | TC | $97.72 | $154.88 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $173.78 / $173.78
| Facility | 26 | $53.70 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $190.55 / $1,047.13
| Professional | | $123.03 | $190.55 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $302.00
| Professional | 26 | $21.88 | $34.67 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $154.88 / $912.01
| Professional | TC | $97.72 | $154.88 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $158.49 / $245.47
| Professional | | $120.23 | $158.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $27.54 / $45.71
| Professional | 26 | $20.42 | $27.54 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $125.89 / $204.17
| Professional | TC | $97.72 | $125.89 | $204.17 |