- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $15.85
| Facility | 26 | $12.02 | $12.02 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $109.65 / $275.42
| Professional | | $77.62 | $109.65 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.88 / $54.95
| Professional | 26 | $10.00 | $12.88 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $95.50 / $218.78
| Professional | TC | $67.61 | $95.50 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $123.03 / $398.11
| Professional | | $61.66 | $123.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $15.49 / $22.91
| Professional | 26 | $11.22 | $15.49 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $104.71 / $239.88
| Professional | TC | $51.29 | $104.71 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.99
| Facility | 26 | $23.44 | $23.44 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $151.36 / $302.00
| Professional | | $95.50 | $151.36 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $14.45 / $26.92
| Professional | 26 | $10.00 | $14.45 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $138.04 / $251.19
| Professional | TC | $83.18 | $138.04 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $162.18 / $537.03
| Professional | | $147.91 | $162.18 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $18.20 / $53.70
| Professional | 26 | $16.60 | $18.20 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $144.54 / $478.63
| Professional | TC | $131.83 | $144.54 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $104.71 / $151.36
| Professional | | $91.20 | $104.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $18.62
| Professional | 26 | $11.48 | $11.48 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $93.33 / $134.90
| Professional | TC | $81.28 | $93.33 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $162.18 / $263.03
| Professional | | $114.82 | $162.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $19.95 / $31.62
| Professional | 26 | $10.72 | $19.95 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $141.25 / $239.88
| Professional | TC | $95.50 | $141.25 | $239.88 |