- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $13.80 / $17.78
| Facility | 26 | $10.23 | $13.80 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $346.74
| Facility | TC | $22.91 | $34.67 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $138.04
| Professional | | $30.20 | $42.66 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.60 / $34.67
| Professional | 26 | $10.00 | $16.60 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $63.10
| Professional | TC | $19.95 | $30.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $31.62 / $57.54
| Professional | | $22.39 | $31.62 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $12.30 / $20.42
| Professional | 26 | $8.51 | $12.30 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $26.92 / $44.67
| Professional | TC | $15.49 | $26.92 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.90 / $51.29
| Professional | | $30.20 | $30.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $17.78
| Professional | 26 | $11.22 | $11.22 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $19.95 / $33.88
| Professional | TC | $19.50 | $19.95 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $28.84 / $45.71
| Professional | | $11.75 | $28.84 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $42.66 / $70.79
| Professional | | $29.51 | $42.66 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $14.45 / $22.91
| Professional | 26 | $9.12 | $14.45 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $51.29
| Professional | TC | $20.42 | $28.18 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $67.61
| Professional | | $30.20 | $36.31 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $12.59 / $33.88
| Professional | 26 | $10.23 | $12.59 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $24.55 / $46.77
| Professional | TC | $19.95 | $24.55 | $46.77 |