- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $57.54 / $102.33
| Facility | 26 | $13.49 | $57.54 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $85.11 / $213.80
| Facility | TC | $37.15 | $85.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $50.12 / $117.49
| Professional | | $35.48 | $50.12 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $16.98 / $41.69
| Professional | 26 | $10.96 | $16.98 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $66.07
| Professional | TC | $21.88 | $32.36 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $11.22
| Facility | 26 | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $23.99
| Facility | TC | $23.99 | $23.99 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $57.54 / $95.50
| Professional | | $35.48 | $57.54 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $19.50 / $31.62
| Professional | 26 | $10.72 | $19.50 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $38.02 / $66.07
| Professional | TC | $23.99 | $38.02 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $61.66 / $74.13
| Professional | | $44.67 | $61.66 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $17.78 / $20.89
| Professional | 26 | $12.88 | $17.78 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $44.67 / $53.70
| Professional | TC | $32.36 | $44.67 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $9,332.54 / $25,703.96
| Facility | TC | $34.67 | $9,332.54 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $44.67 / $97.72
| Professional | | $38.02 | $44.67 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $14.13 / $30.90
| Professional | 26 | $11.75 | $14.13 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $30.90 / $63.10
| Professional | TC | $26.30 | $30.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $87.10
| Professional | | $33.88 | $51.29 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.60 / $29.51
| Professional | 26 | $10.00 | $16.60 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $34.67 / $58.88
| Professional | TC | $23.44 | $34.67 | $58.88 |