- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $26.30 / $81.28
| Facility | 26 | $10.96 | $26.30 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $69.18 / $213.80
| Facility | TC | $28.84 | $69.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $42.66 / $91.20
| Professional | | $32.36 | $42.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $17.38 / $35.48
| Professional | 26 | $10.00 | $17.38 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $28.18 / $50.12
| Professional | TC | $20.89 | $28.18 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $47.86 / $154.88
| Professional | | $30.90 | $47.86 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $13.49
| Professional | 26 | $12.02 | $12.02 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $34.67 / $34.67
| Professional | TC | $30.90 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $104.71
| Professional | | $33.88 | $46.77 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $15.49 / $33.11
| Professional | 26 | $10.72 | $15.49 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $30.90 / $75.86
| Professional | TC | $23.44 | $30.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $48.98 / $102.33
| Professional | | $40.74 | $48.98 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $13.49 / $28.18
| Professional | 26 | $11.48 | $13.49 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $34.67 / $74.13
| Professional | TC | $29.51 | $34.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $95.50 / $257.04
| Professional | | $34.67 | $95.50 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $75.86 / $95.50
| Professional | 26 | $12.02 | $75.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $91.20 / $181.97
| Professional | TC | $23.44 | $91.20 | $181.97 |