- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $41.69
| Facility | 26 | $22.39 | $22.39 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $95.50
| Professional | | $30.90 | $52.48 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $38.90
| Professional | 26 | $16.98 | $21.88 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.00 / $30.90 / $46.77
| Professional | TC | $10.00 | $30.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $75.86 / $75.86
| Professional | | $57.54 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $21.88
| Professional | 26 | $18.20 | $18.20 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $56.23 / $100.00
| Professional | | $8.32 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $33.11 / $47.86
| Professional | 26 | $22.39 | $33.11 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $33.88 / $64.57
| Professional | TC | $15.14 | $33.88 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $23.44 / $33.11
| Facility | 26 | $5.01 | $23.44 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $50.12 / $104.71
| Professional | | $36.31 | $50.12 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $50.12
| Professional | 26 | $20.89 | $28.84 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $25.70 / $61.66
| Professional | TC | $11.22 | $25.70 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | 26 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $436.52 / $436.52
| Professional | | $354.81 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $165.96 / $165.96
| Professional | 26 | $131.83 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $269.15 / $269.15
| Professional | TC | $223.87 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $45.71 / $83.18
| Professional | | $31.62 | $45.71 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $42.66
| Professional | 26 | $19.05 | $25.70 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.33 / $22.91 / $43.65
| Professional | TC | $9.33 | $22.91 | $43.65 |