- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $28.84 / $77.62
| Facility | 26 | $18.62 | $28.84 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $81.28 / $281.84
| Professional | | $48.98 | $81.28 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $30.90 / $85.11
| Professional | 26 | $16.98 | $30.90 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $97.72
| Professional | TC | $30.20 | $42.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $47.86 / $60.26
| Professional | | $38.02 | $47.86 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $18.62 / $31.62
| Professional | 26 | $13.49 | $18.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $46.77 / $100.00
| Professional | | $19.05 | $46.77 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $75.86 / $128.82
| Professional | | $48.98 | $75.86 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $39.81
| Professional | 26 | $17.78 | $25.70 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $50.12 / $91.20
| Professional | TC | $34.67 | $50.12 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $109.65 / $398.11
| Professional | | $54.95 | $109.65 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $177.83
| Professional | 26 | $19.05 | $30.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $72.44 / $263.03
| Professional | TC | $36.31 | $72.44 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $60.26 / $64.57
| Professional | | $58.88 | $60.26 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $22.39
| Professional | 26 | $21.38 | $21.38 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $38.90 / $42.66
| Professional | TC | $38.02 | $38.90 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $75.86 / $125.89
| Professional | | $51.29 | $75.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $23.44 / $37.15
| Professional | 26 | $17.38 | $23.44 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $48.98 / $91.20
| Professional | TC | $33.11 | $48.98 | $91.20 |