- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $25.70 / $79.43
| Facility | 26 | $10.96 | $25.70 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $46.77 / $109.65
| Professional | | $33.11 | $46.77 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $19.05 / $41.69
| Professional | 26 | $10.00 | $19.05 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $74.13
| Professional | TC | $20.89 | $28.84 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $43.65 / $173.78
| Professional | | $31.62 | $43.65 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $13.18 / $15.85
| Professional | 26 | $11.75 | $13.18 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $31.62 / $31.62
| Professional | TC | $27.54 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $45.71 / $104.71
| Professional | | $33.88 | $45.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $15.14 / $32.36
| Professional | 26 | $10.47 | $15.14 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $30.90 / $75.86
| Professional | TC | $23.44 | $30.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $51.29 / $100.00
| Professional | | $43.65 | $51.29 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $13.80 / $27.54
| Professional | 26 | $11.75 | $13.80 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $37.15 / $74.13
| Professional | TC | $31.62 | $37.15 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $95.50 / $269.15
| Professional | | $34.67 | $95.50 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $77.62 / $95.50
| Professional | 26 | $12.02 | $77.62 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $40.74 / $131.83
| Professional | TC | $22.39 | $40.74 | $131.83 |