- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $48.98 / $87.10
| Facility | 26 | $10.96 | $48.98 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $102.33 / $218.78
| Facility | TC | $30.20 | $102.33 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $43.65 / $109.65
| Professional | | $36.31 | $43.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $21.88 / $50.12
| Professional | 26 | $10.96 | $21.88 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $61.66
| Professional | TC | $21.88 | $28.84 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $50.12 / $190.55
| Professional | | $12.88 | $50.12 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $14.13 / $18.20
| Professional | 26 | $12.59 | $14.13 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $36.31 / $36.31
| Professional | TC | $32.36 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $57.54 / $114.82
| Professional | | $37.15 | $57.54 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $19.05 / $37.15
| Professional | 26 | $11.48 | $19.05 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $77.62
| Professional | TC | $25.12 | $38.90 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $50.12 / $104.71
| Professional | | $42.66 | $50.12 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $34.67
| Professional | 26 | $12.02 | $14.13 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $36.31 / $75.86
| Professional | TC | $30.90 | $36.31 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $95.50 / $295.12
| Professional | | $42.66 | $95.50 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $95.50 / $102.33
| Professional | 26 | $13.18 | $95.50 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $43.65 / $147.91
| Professional | TC | $26.92 | $43.65 | $147.91 |