- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.57 / $7.24 / $9.77
| Facility | 26 | $4.57 | $7.24 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $44.67 / $93.33
| Professional | | $21.88 | $44.67 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.88 / $5.25 / $15.85
| Professional | 26 | $2.88 | $5.25 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $33.88 / $85.11
| Professional | TC | $18.20 | $33.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $43.65 / $54.95
| Professional | | $42.66 | $43.65 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.75 / $6.03 / $6.92
| Professional | 26 | $2.75 | $6.03 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $34.67 / $47.86
| Professional | | $20.89 | $34.67 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $4.68 / $6.46
| Professional | 26 | $2.82 | $4.68 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $30.20 / $40.74
| Professional | TC | $18.20 | $30.20 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $50.12 / $100.00
| Professional | | $20.89 | $50.12 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $6.46 / $8.51
| Professional | 26 | $3.02 | $6.46 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $42.66 / $87.10
| Professional | TC | $18.62 | $42.66 | $87.10 |
- 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
- $30.20 / $51.29 / $724.44
| Professional | | $30.20 | $51.29 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.89 / $6.31 / $288.40
| Professional | 26 | $3.89 | $6.31 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $43.65 / $660.69
| Professional | TC | $26.30 | $43.65 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $47.86 / $61.66
| Professional | | $45.71 | $47.86 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $6.46 / $8.51
| Professional | 26 | $6.17 | $6.46 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $40.74 / $53.70
| Professional | TC | $38.90 | $40.74 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $169.82
| Professional | | $51.29 | $64.57 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $6.92 / $7.76
| Professional | 26 | $6.03 | $6.92 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $54.95 / $162.18
| Professional | TC | $43.65 | $54.95 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $46.77 / $218.78
| Professional | | $40.74 | $46.77 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $46.77 / $120.23
| Professional | | $28.18 | $46.77 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.63 / $6.17 / $7.94
| Professional | 26 | $3.63 | $6.17 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $39.81 / $95.50
| Professional | TC | $24.55 | $39.81 | $95.50 |