- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $40.74 / $54.95
| Facility | 26 | $31.62 | $40.74 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $147.91
| Professional | | $38.02 | $54.95 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.88 / $35.48
| Professional | 26 | $8.91 | $12.88 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $41.69 / $93.33
| Professional | TC | $28.18 | $41.69 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $38.90 / $45.71
| Professional | | $34.67 | $38.90 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $54.95 / $223.87
| Professional | | $46.77 | $54.95 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $10.72 / $43.65
| Professional | 26 | $9.12 | $10.72 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $44.67 / $181.97
| Professional | TC | $37.15 | $44.67 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $12.88 / $18.62
| Facility | 26 | $2.82 | $12.88 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $56.23 / $109.65
| Professional | | $41.69 | $56.23 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $13.49 / $25.70
| Professional | 26 | $9.55 | $13.49 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $41.69 / $83.18
| Professional | TC | $31.62 | $41.69 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $100.00 / $100.00
| Facility | 26 | $26.92 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $53.70 / $346.74
| Professional | | $44.67 | $53.70 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $13.18 / $141.25
| Professional | 26 | $11.22 | $13.18 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $40.74 / $275.42
| Professional | TC | $33.88 | $40.74 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $52.48 / $112.20
| Professional | | $44.67 | $52.48 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $12.88 / $31.62
| Professional | 26 | $10.96 | $12.88 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $39.81 / $63.10
| Professional | TC | $33.11 | $39.81 | $63.10 |