- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $10.96
| Facility | 26 | $6.03 | $6.03 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $134.90
| Facility | TC | $20.89 | $28.84 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $32.36 / $70.79
| Professional | | $13.49 | $32.36 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $7.94 / $23.44
| Professional | 26 | $5.01 | $7.94 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $25.70 / $70.79
| Professional | TC | $16.98 | $25.70 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $67.61 / $74.13
| Professional | | $50.12 | $67.61 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $14.79 / $16.22
| Professional | 26 | $10.96 | $14.79 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $52.48 / $58.88
| Professional | TC | $39.81 | $52.48 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $43.65 / $74.13
| Professional | | $25.12 | $43.65 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $9.33 / $15.85
| Professional | 26 | $6.46 | $9.33 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $34.67 / $58.88
| Professional | TC | $18.20 | $34.67 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $75.86 / $109.65
| Facility | TC | $57.54 | $75.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $51.29 / $186.21
| Professional | | $26.92 | $51.29 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $12.59 / $54.95
| Professional | 26 | $6.92 | $12.59 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $39.81 / $147.91
| Professional | TC | $20.89 | $39.81 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $50.12 / $100.00
| Professional | | $26.92 | $50.12 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $11.75 / $30.20
| Professional | 26 | $6.46 | $11.75 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $38.90 / $100.00
| Professional | TC | $20.42 | $38.90 | $100.00 |