- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $15.85 / $707.95
| Facility | 26 | $14.79 | $15.85 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $70.79 / $125.89
| Professional | | $46.77 | $70.79 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $19.50 / $39.81
| Professional | 26 | $10.96 | $19.50 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $42.66 / $93.33
| Professional | TC | $30.90 | $42.66 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $74.13 / $100.00
| Professional | | $45.71 | $74.13 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $17.78 / $26.92
| Professional | 26 | $10.72 | $17.78 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $53.70 / $75.86
| Professional | TC | $35.48 | $53.70 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $128.82
| Professional | | $51.29 | $72.44 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $20.89 / $36.31
| Professional | 26 | $14.45 | $20.89 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $52.48 / $97.72
| Professional | TC | $35.48 | $52.48 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $81.28 / $151.36
| Professional | | $64.57 | $81.28 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $19.50 / $36.31
| Professional | 26 | $15.49 | $19.50 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $61.66 / $117.49
| Professional | TC | $48.98 | $61.66 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $1,778.28
| Facility | 26 | $14.79 | $14.79 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $66.07 / $120.23
| Professional | | $47.86 | $66.07 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $16.60 / $31.62
| Professional | 26 | $12.02 | $16.60 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $91.20
| Professional | TC | $33.88 | $48.98 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $151.36
| Professional | | $51.29 | $77.62 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $21.88 / $95.50
| Professional | 26 | $13.49 | $21.88 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $53.70 / $102.33
| Professional | TC | $35.48 | $53.70 | $102.33 |