- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $14.79 / $20.89
| Facility | 26 | $11.75 | $14.79 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $66.07 / $213.80
| Professional | | $50.12 | $66.07 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $18.62 / $50.12
| Professional | 26 | $10.96 | $18.62 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $46.77 / $102.33
| Professional | TC | $38.02 | $46.77 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $54.95 / $87.10
| Professional | | $47.86 | $54.95 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $12.88 / $19.05
| Professional | 26 | $10.23 | $12.88 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $13.80
| Professional | 52 | $13.80 | $13.80 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $54.95 / $87.10
| Professional | | $44.67 | $54.95 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $12.88 / $20.42
| Professional | 26 | $10.72 | $12.88 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $41.69 / $67.61
| Professional | TC | $33.88 | $41.69 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $72.44 / $107.15
| Professional | | $61.66 | $72.44 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $15.14 / $20.89
| Professional | 26 | $12.59 | $15.14 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $57.54 / $85.11
| Professional | TC | $48.98 | $57.54 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.05
| Facility | 26 | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $69.18 / $112.20
| Professional | | $51.29 | $69.18 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $16.22 / $25.70
| Professional | 26 | $12.02 | $16.22 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $53.70 / $87.10
| Professional | TC | $38.90 | $53.70 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $79.43 / $79.43
| Facility | 26 | $28.18 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $69.18 / $346.74
| Professional | | $48.98 | $69.18 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $16.22 / $74.13
| Professional | 26 | $11.48 | $16.22 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $53.70 / $269.15
| Professional | TC | $37.15 | $53.70 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $63.10 / $100.00
| Professional | | $46.77 | $63.10 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $14.45 / $25.70
| Professional | 26 | $10.47 | $14.45 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $47.86 / $77.62
| Professional | TC | $35.48 | $47.86 | $77.62 |