- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $10.00 / $14.45
| Facility | 26 | $8.32 | $10.00 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $66.07 / $147.91
| Professional | | $51.29 | $66.07 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $22.91
| Professional | 26 | $7.94 | $10.00 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $8.32
| Professional | 52 | $8.13 | $8.13 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $51.29 / $93.33
| Professional | TC | $42.66 | $51.29 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $58.88 / $81.28
| Professional | | $51.29 | $58.88 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $10.00 / $13.49
| Professional | 26 | $7.76 | $10.00 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $63.10 / $75.86
| Professional | TC | $44.67 | $63.10 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $54.95 / $87.10
| Professional | | $43.65 | $54.95 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $8.71 / $13.80
| Professional | 26 | $6.92 | $8.71 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $46.77 / $74.13
| Professional | TC | $37.15 | $46.77 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $50.12 / $70.79
| Professional | | $9.55 | $50.12 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $14.13
| Facility | 26 | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $70.79 / $109.65
| Professional | | $53.70 | $70.79 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $11.22 / $17.38
| Professional | 26 | $8.32 | $11.22 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $58.88 / $91.20
| Professional | TC | $43.65 | $58.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $58.88 / $91.20
| Professional | | $46.77 | $58.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $9.55 / $15.85
| Professional | 26 | $7.59 | $9.55 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $48.98 / $75.86
| Professional | TC | $38.90 | $48.98 | $75.86 |