- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $40.74 / $60.26
| Facility | 26 | $7.94 | $40.74 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $275.42
| Professional | | $21.88 | $36.31 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $11.22 / $51.29
| Professional | 26 | $8.91 | $11.22 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $19.50 / $218.78
| Professional | TC | $12.88 | $19.50 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $25.70 / $309.03
| Professional | | $10.00 | $25.70 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $10.47
| Professional | 26 | $8.91 | $8.91 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $19.05 / $54.95
| Professional | TC | $16.98 | $19.05 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $44.67 / $154.88
| Professional | | $20.42 | $44.67 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.75 / $25.12
| Professional | 26 | $7.94 | $11.75 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.18 / $25.12 / $144.54
| Professional | TC | $13.18 | $25.12 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $58.88
| Professional | | $24.55 | $28.84 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $10.23 / $20.89
| Professional | 26 | $8.71 | $10.23 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $38.02
| Professional | TC | $15.85 | $19.05 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $91.20 / $371.54
| Professional | | $21.88 | $91.20 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $58.88 / $95.50
| Professional | 26 | $9.12 | $58.88 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.18 / $28.84 / $107.15
| Professional | TC | $13.18 | $28.84 | $107.15 |