- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $32.36 / $97.72
| Facility | 26 | $12.88 | $32.36 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $36.31 / $67.61
| Professional | | $15.85 | $36.31 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $19.95 / $34.67
| Professional | 26 | $10.72 | $19.95 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.76 / $23.99 / $43.65
| Professional | TC | $7.76 | $23.99 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $43.65 / $89.13
| Professional | | $17.38 | $43.65 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $14.45 / $15.85
| Professional | 26 | $8.51 | $14.45 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $32.36 / $32.36
| Professional | TC | $28.84 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $33.88 / $102.33
| Professional | | $19.95 | $33.88 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.02 / $33.88
| Professional | 26 | $7.59 | $12.02 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.72 / $20.89 / $67.61
| Professional | TC | $10.72 | $20.89 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $100.00
| Professional | | $33.88 | $46.77 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $15.85 / $33.11
| Professional | 26 | $13.49 | $15.85 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $31.62 / $67.61
| Professional | TC | $18.20 | $31.62 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $97.72 / $125.89
| Professional | | $20.42 | $97.72 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $43.65 / $95.50
| Professional | 26 | $12.59 | $43.65 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.23 / $33.88 / $87.10
| Professional | TC | $10.23 | $33.88 | $87.10 |