- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $16.98 / $45.71
| Facility | 26 | $9.55 | $16.98 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $61.66 / $194.98
| Professional | | $35.48 | $61.66 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | 25 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $14.13 / $42.66
| Professional | 26 | $9.33 | $14.13 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $69.18
| Professional | TC | $25.70 | $38.02 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $39.81 / $74.13
| Professional | | $31.62 | $39.81 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $11.75 / $19.50
| Professional | 26 | $9.12 | $11.75 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $30.90 / $58.88
| Professional | TC | $26.30 | $30.90 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $112.20
| Professional | | $42.66 | $67.61 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $18.20 / $26.92
| Professional | 26 | $12.30 | $18.20 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $60.26 / $89.13
| Professional | TC | $40.74 | $60.26 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.45 / $11.48 / $16.60
| Facility | 26 | $2.45 | $11.48 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $64.57 / $104.71
| Professional | | $41.69 | $64.57 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $16.60 / $26.30
| Professional | 26 | $10.96 | $16.60 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $48.98 / $81.28
| Professional | TC | $30.20 | $48.98 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Professional | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Professional | 26 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $269.15
| Professional | TC | $245.47 | $245.47 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $66.07 / $104.71
| Professional | | $47.86 | $66.07 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.85 / $25.70
| Professional | 26 | $10.96 | $15.85 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $50.12 / $81.28
| Professional | TC | $36.31 | $50.12 | $81.28 |