- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $41.69 / $48.98
| Facility | 26 | $13.18 | $41.69 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $151.36
| Professional | | $28.18 | $39.81 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $13.80 / $33.88
| Professional | 26 | $7.94 | $13.80 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $25.12 / $67.61
| Professional | TC | $18.20 | $25.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $44.67 / $74.13
| Professional | | $28.84 | $44.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $13.49 / $22.91
| Professional | 26 | $7.76 | $13.49 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $31.62 / $50.12
| Professional | TC | $20.89 | $31.62 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $53.70 / $89.13
| Professional | | $40.74 | $53.70 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $15.14 / $25.12
| Professional | 26 | $11.75 | $15.14 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $38.02 / $72.44
| Professional | TC | $26.30 | $38.02 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $44.67 / $54.95
| Professional | | $36.31 | $44.67 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $13.80 / $16.98
| Professional | 26 | $10.96 | $13.80 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $43.65
| Professional | TC | $25.12 | $36.31 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $20.89 / $57.54
| Professional | | $14.13 | $20.89 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $45.71 / $100.00
| Professional | | $29.51 | $45.71 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $12.88 / $33.88
| Professional | 26 | $9.12 | $12.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $31.62 / $56.23
| Professional | TC | $19.95 | $31.62 | $56.23 |