- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $9.55 / $10.96
| Facility | 26 | $7.08 | $9.55 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $69.18 / $83.18
| Facility | TC | $19.05 | $69.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $30.90 / $74.13
| Professional | | $19.05 | $30.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $9.77 / $25.12
| Professional | 26 | $7.08 | $9.77 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $22.91 / $47.86
| Professional | TC | $16.98 | $22.91 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $8.51 / $8.51
| Professional | 26 | $8.51 | $8.51 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $123.03
| Facility | TC | $91.20 | $91.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $61.66 / $100.00
| Professional | | $33.11 | $61.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $20.89 / $50.12
| Professional | 26 | $9.12 | $20.89 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $28.84 / $52.48
| Professional | TC | $23.44 | $28.84 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $37.15 / $61.66
| Professional | | $28.84 | $37.15 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $12.02 / $20.42
| Professional | 26 | $9.55 | $12.02 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $25.12 / $40.74
| Professional | TC | $19.95 | $25.12 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $35.48 / $61.66
| Professional | | $26.30 | $35.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $11.22 / $19.05
| Professional | 26 | $8.91 | $11.22 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $23.99 / $42.66
| Professional | TC | $17.38 | $23.99 | $42.66 |