- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $38.02 / $60.26
| Facility | 26 | $7.94 | $38.02 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $245.47
| Professional | | $32.36 | $51.29 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.59 / $30.90
| Professional | 26 | $7.94 | $12.59 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $204.17
| Professional | TC | $22.91 | $33.11 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $39.81 / $239.88
| Professional | | $10.00 | $39.81 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $8.91 / $9.77
| Professional | 26 | $8.91 | $8.91 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $34.67 / $44.67
| Professional | TC | $30.90 | $34.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $74.13 / $144.54
| Professional | | $33.88 | $74.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.48 / $25.12
| Professional | 26 | $7.94 | $11.48 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $48.98 / $117.49
| Professional | TC | $25.12 | $48.98 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $45.71 / $93.33
| Professional | | $38.90 | $45.71 | $93.33 |
- 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
- $30.20 / $35.48 / $72.44
| Professional | TC | $30.20 | $35.48 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $95.50 / $309.03
| Professional | | $38.02 | $95.50 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $60.26 / $95.50
| Professional | 26 | $9.12 | $60.26 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $51.29 / $288.40
| Professional | TC | $26.92 | $51.29 | $288.40 |