- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $17.38 / $40.74
| Facility | 26 | $12.02 | $17.38 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $102.33 / $275.42
| Professional | | $77.62 | $102.33 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $12.30 / $51.29
| Professional | 26 | $10.96 | $12.30 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $89.13 / $218.78
| Professional | TC | $67.61 | $89.13 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $8.91
| Professional | 26 | $8.91 | $8.91 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $100.00 / $162.18
| Professional | | $74.13 | $100.00 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $16.60 / $27.54
| Professional | 26 | $13.18 | $16.60 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $83.18 / $138.04
| Professional | TC | $60.26 | $83.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $151.36 / $281.84
| Professional | | $93.33 | $151.36 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $15.49 / $27.54
| Professional | 26 | $10.23 | $15.49 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $131.83 / $251.19
| Professional | TC | $81.28 | $131.83 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.88 / $13.49 / $19.05
| Facility | 26 | $2.88 | $13.49 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $147.91 / $281.84
| Professional | | $89.13 | $147.91 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $15.49 / $25.70
| Professional | 26 | $10.23 | $15.49 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $131.83 / $239.88
| Professional | TC | $81.28 | $131.83 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $32.36 / $50.12
| Professional | | $13.80 | $32.36 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Facility | 26 | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $117.49 / $208.93
| Professional | | $95.50 | $117.49 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $14.45 / $25.70
| Professional | 26 | $11.75 | $14.45 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $104.71 / $186.21
| Professional | TC | $83.18 | $104.71 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $128.82 / $218.78
| Professional | | $93.33 | $128.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $12.88 / $23.99
| Professional | 26 | $9.77 | $12.88 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $114.82 / $194.98
| Professional | TC | $81.28 | $114.82 | $194.98 |