- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $15.49 / $18.20
| Facility | 26 | $15.14 | $15.49 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $72.44 / $125.89
| Professional | | $45.71 | $72.44 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $18.20 / $40.74
| Professional | 26 | $12.02 | $18.20 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $93.33
| Professional | TC | $30.90 | $45.71 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $77.62 / $102.33
| Professional | | $47.86 | $77.62 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $18.20 / $26.92
| Professional | 26 | $11.22 | $18.20 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $52.48 / $77.62
| Professional | TC | $36.31 | $52.48 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $72.44 / $134.90
| Professional | | $50.12 | $72.44 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $20.89 / $37.15
| Professional | 26 | $14.45 | $20.89 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $52.48 / $100.00
| Professional | TC | $35.48 | $52.48 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $89.13 / $165.96
| Professional | | $64.57 | $89.13 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $37.15
| Professional | 26 | $15.85 | $19.95 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $120.23
| Professional | TC | $50.12 | $64.57 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $15.49 / $1,819.70
| Facility | 26 | $15.14 | $15.49 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $67.61 / $123.03
| Professional | | $46.77 | $67.61 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $17.38 / $32.36
| Professional | 26 | $12.59 | $17.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $93.33
| Professional | TC | $33.88 | $50.12 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $74.13 / $154.88
| Professional | | $53.70 | $74.13 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $22.39 / $95.50
| Professional | 26 | $14.13 | $22.39 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $52.48 / $104.71
| Professional | TC | $36.31 | $52.48 | $104.71 |