- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $33.11 / $81.28
| Facility | 26 | $10.96 | $33.11 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $83.18 / $173.78
| Professional | | $42.66 | $83.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $24.55 / $45.71
| Professional | 26 | $12.02 | $24.55 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $58.88 / $123.03
| Professional | TC | $30.90 | $58.88 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $54.95 / $194.98
| Professional | | $37.15 | $54.95 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $12.59 / $13.80
| Professional | 26 | $12.30 | $12.59 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $42.66 / $42.66
| Professional | TC | $40.74 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $58.88 / $131.83
| Professional | | $43.65 | $58.88 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $17.38 / $35.48
| Professional | 26 | $10.96 | $17.38 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $40.74 / $100.00
| Professional | TC | $33.11 | $40.74 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $63.10 / $125.89
| Professional | | $53.70 | $63.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $30.90
| Professional | 26 | $12.02 | $14.13 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $50.12 / $100.00
| Professional | TC | $41.69 | $50.12 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $95.50 / $302.00
| Professional | | $46.77 | $95.50 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $95.50 / $95.50
| Professional | 26 | $12.88 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $95.50 / $208.93
| Professional | TC | $34.67 | $95.50 | $208.93 |