- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $20.89
| Facility | 26 | $16.98 | $16.98 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $79.43 / $158.49
| Professional | | $63.10 | $79.43 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $16.98 / $36.31
| Professional | 26 | $14.13 | $16.98 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $61.66 / $120.23
| Professional | TC | $45.71 | $61.66 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $61.66
| Professional | | $53.70 | $53.70 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $74.13 / $123.03
| Professional | | $72.44 | $74.13 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $26.92
| Professional | 26 | $16.22 | $16.22 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $58.88 / $95.50
| Professional | TC | $56.23 | $58.88 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $134.90
| Professional | | $57.54 | $91.20 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $21.38 / $29.51
| Professional | 26 | $13.80 | $21.38 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $67.61 / $107.15
| Professional | TC | $43.65 | $67.61 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $95.50 / $128.82
| Professional | | $0.32 | $95.50 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.11 / $20.42 / $26.92
| Professional | 26 | $0.11 | $20.42 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1.05 / $81.28 / $100.00
| Professional | TC | $1.05 | $81.28 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.32 / $120.23
| Professional | | $0.32 | $0.32 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.11 / $0.11 / $25.12
| Professional | 26 | $0.11 | $0.11 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.21 / $89.13 / $93.33
| Professional | TC | $0.21 | $89.13 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $79.43 / $81.28
| Professional | | $75.86 | $79.43 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $16.98 / $17.38
| Professional | 26 | $16.60 | $16.98 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $63.10 / $63.10
| Professional | TC | $58.88 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $79.43 / $123.03
| Professional | | $53.70 | $79.43 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $18.62 / $31.62
| Professional | 26 | $14.13 | $18.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $61.66 / $91.20
| Professional | TC | $39.81 | $61.66 | $91.20 |