- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $15.49 / $27.54
| Facility | 26 | $7.94 | $15.49 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $41.69 / $363.08
| Facility | TC | $21.88 | $41.69 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $35.48 / $109.65
| Professional | | $16.98 | $35.48 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.88 / $35.48
| Professional | 26 | $7.94 | $12.88 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $23.99 / $46.77
| Professional | TC | $18.20 | $23.99 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $25.70 / $41.69
| Professional | | $21.88 | $25.70 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $8.71 / $12.30
| Professional | 26 | $6.92 | $8.71 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $38.90 / $74.13
| Professional | | $11.48 | $38.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $40.74 / $61.66
| Professional | | $25.70 | $40.74 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.88 / $18.62
| Professional | 26 | $7.59 | $12.88 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $28.84 / $45.71
| Professional | TC | $18.20 | $28.84 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $97.72 / $199.53
| Professional | | $39.81 | $97.72 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $22.91 / $100.00
| Professional | 26 | $10.47 | $22.91 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $36.31 / $114.82
| Professional | TC | $26.92 | $36.31 | $114.82 |
- 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
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | TC | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $43.65
| Professional | | $39.81 | $39.81 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $11.22 / $12.02
| Professional | 26 | $10.96 | $11.22 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $28.18 / $31.62
| Professional | TC | $26.92 | $28.18 | $31.62 |
- 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
- $30.20 / $51.29 / $97.72
| Professional | | $30.20 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $14.79 / $58.88
| Professional | 26 | $9.55 | $14.79 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $26.30 / $39.81
| Professional | TC | $19.05 | $26.30 | $39.81 |