- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $34.67 / $89.13
| Facility | 26 | $32.36 | $34.67 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $41.69 / $131.83
| Professional | | $22.91 | $41.69 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.30 / $33.88
| Professional | 26 | $7.94 | $12.30 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $25.70 / $69.18
| Professional | TC | $15.14 | $25.70 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $54.95 / $102.33
| Professional | | $41.69 | $54.95 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $18.20 / $35.48
| Professional | 26 | $12.59 | $18.20 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $36.31 / $69.18
| Professional | TC | $28.84 | $36.31 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $34.67 / $89.13
| Facility | 26 | $32.36 | $34.67 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $89.13 / $144.54
| Professional | | $40.74 | $89.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $30.20 / $74.13
| Professional | 26 | $12.02 | $30.20 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $61.66 / $95.50
| Professional | TC | $25.12 | $61.66 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $141.25 / $213.80
| Professional | | $131.83 | $141.25 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $41.69 / $72.44
| Professional | 26 | $37.15 | $41.69 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $144.54
| Professional | TC | $70.79 | $100.00 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $87.10 / $102.33
| Professional | | $43.65 | $87.10 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $15.14 / $38.02
| Professional | 26 | $8.51 | $15.14 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $69.18
| Professional | TC | $20.89 | $30.20 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $83.18 / $204.17
| Professional | | $40.74 | $83.18 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $30.20 / $66.07
| Professional | 26 | $11.48 | $30.20 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $52.48 / $112.20
| Professional | TC | $28.84 | $52.48 | $112.20 |