- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $30.90 / $194.98
| Facility | 26 | $30.20 | $30.90 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $53.70 / $97.72
| Professional | | $34.67 | $53.70 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $39.81
| Professional | 26 | $16.98 | $21.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $33.88 / $56.23
| Professional | TC | $12.02 | $33.88 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Professional | 26 | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $36.31 / $63.10
| Professional | | $19.50 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $48.98 / $81.28
| Professional | | $33.11 | $48.98 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $38.02
| Professional | 26 | $19.50 | $27.54 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.72 / $16.60 / $44.67
| Professional | TC | $10.72 | $16.60 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $43.65
| Professional | | $32.36 | $33.11 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $54.95 / $95.50
| Professional | | $34.67 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $38.02
| Professional | 26 | $20.42 | $28.18 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.72 / $16.60 / $44.67
| Professional | TC | $10.72 | $16.60 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $52.48 / $81.28
| Professional | | $40.74 | $52.48 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $30.90 / $41.69
| Professional | 26 | $22.39 | $30.90 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.49 / $19.50 / $43.65
| Professional | TC | $13.49 | $19.50 | $43.65 |