- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $14.45 / $20.89
| Facility | 26 | $12.30 | $14.45 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $104.71 / $234.42
| Professional | | $70.79 | $104.71 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $16.60 / $36.31
| Professional | 26 | $10.96 | $16.60 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $19.05 / $295.12 / $371.54
| Professional | 52 | $19.05 | $295.12 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $81.28 / $144.54
| Professional | TC | $63.10 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $75.86 / $85.11
| Professional | | $61.66 | $75.86 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $13.18 / $15.49
| Professional | 26 | $8.91 | $13.18 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $18.62
| Professional | 52 | $18.62 | $18.62 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Professional | TC | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $91.20 / $114.82
| Professional | | $74.13 | $91.20 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $11.48 / $18.20
| Professional | 26 | $9.77 | $11.48 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $100.00
| Professional | TC | $54.95 | $79.43 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $66.07 / $95.50
| Professional | | $11.75 | $66.07 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.88 / $13.49 / $19.05
| Facility | 26 | $2.88 | $13.49 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $128.82 / $407.38
| Professional | | $74.13 | $128.82 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $17.78 / $89.13
| Professional | 26 | $11.48 | $17.78 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $114.82 / $363.08
| Professional | TC | $67.61 | $114.82 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.88
| Professional | | $32.36 | $33.11 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $104.71 / $177.83
| Professional | | $74.13 | $104.71 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $13.49 / $25.12
| Professional | 26 | $10.72 | $13.49 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $151.36
| Professional | TC | $63.10 | $91.20 | $151.36 |