- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $16.22 / $38.02
| Facility | 26 | $10.96 | $16.22 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $74.13 / $208.93
| Professional | | $44.67 | $74.13 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $20.89 / $57.54
| Professional | 26 | $11.75 | $20.89 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $100.00
| Professional | TC | $32.36 | $50.12 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $41.69 / $66.07
| Professional | | $33.88 | $41.69 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $12.02 / $18.62
| Professional | 26 | $9.55 | $12.02 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $43.65 / $53.70
| Professional | TC | $29.51 | $43.65 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $60.26 / $104.71
| Professional | | $15.85 | $60.26 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $69.18 / $100.00
| Professional | | $42.66 | $69.18 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $19.05 / $29.51
| Professional | 26 | $11.22 | $19.05 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $50.12 / $75.86
| Professional | TC | $30.90 | $50.12 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $109.65 / $295.12
| Professional | | $61.66 | $109.65 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $22.91 / $107.15
| Professional | 26 | $15.14 | $22.91 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $61.66 / $194.98
| Professional | TC | $43.65 | $61.66 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $63.10 / $67.61
| Professional | | $61.66 | $63.10 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $15.85 / $16.60
| Professional | 26 | $15.49 | $15.85 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $46.77 / $51.29
| Professional | TC | $45.71 | $46.77 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $79.43 / $138.04
| Professional | | $48.98 | $79.43 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $20.89 / $63.10
| Professional | 26 | $13.49 | $20.89 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $60.26 / $114.82
| Professional | TC | $34.67 | $60.26 | $114.82 |