- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $13.49 / $33.11
| Facility | 26 | $9.77 | $13.49 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $134.90
| Professional | | $32.36 | $57.54 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $15.85 / $31.62
| Professional | 26 | $8.71 | $15.85 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $79.43
| Professional | TC | $21.88 | $36.31 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $30.90 / $95.50
| Professional | | $28.84 | $30.90 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $26.92
| Professional | 26 | $10.96 | $15.14 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $30.20 / $45.71
| Professional | TC | $28.18 | $30.20 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Professional | | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $21.88 / $28.84
| Professional | 26 | $14.45 | $21.88 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $46.77 / $75.86
| Professional | TC | $36.31 | $46.77 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $53.70 / $97.72
| Professional | | $31.62 | $53.70 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $15.14 / $27.54
| Professional | 26 | $8.71 | $15.14 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $37.15 / $67.61
| Professional | TC | $22.91 | $37.15 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $16.60
| Professional | 26 | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $38.02 / $77.62
| Professional | | $10.96 | $38.02 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $43.65 / $89.13
| Professional | | $32.36 | $43.65 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $13.49 / $30.90
| Professional | 26 | $9.33 | $13.49 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $31.62 / $64.57
| Professional | TC | $22.91 | $31.62 | $64.57 |
- 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
- $251.19 / $251.19 / $331.13
| Professional | | $251.19 | $251.19 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Professional | 26 | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $245.47
| Professional | TC | $181.97 | $181.97 | $245.47 |