- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $15.14 / $15.14
| Facility | 26 | $8.91 | $15.14 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $257.04
| Professional | | $52.48 | $63.10 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $9.55 / $34.67
| Professional | 26 | $7.59 | $9.55 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $50.12 / $87.10
| Professional | TC | $42.66 | $50.12 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $107.15
| Professional | | $48.98 | $70.79 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $11.22 / $18.20
| Professional | 26 | $8.13 | $11.22 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $60.26 / $89.13
| Professional | TC | $41.69 | $60.26 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $102.33
| Professional | | $32.36 | $33.11 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $79.43 / $117.49
| Professional | | $61.66 | $79.43 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $12.02 / $20.89
| Professional | 26 | $9.33 | $12.02 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $67.61 / $95.50
| Professional | TC | $52.48 | $67.61 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $100.00 / $131.83
| Professional | | $58.88 | $100.00 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $15.85 / $22.39
| Professional | 26 | $9.12 | $15.85 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $74.13 / $87.10
| Professional | TC | $50.12 | $74.13 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $63.10 / $100.00
| Professional | | $11.75 | $63.10 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $63.10 / $93.33
| Professional | | $48.98 | $63.10 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $10.23 / $15.85
| Professional | 26 | $7.76 | $10.23 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $53.70 / $79.43
| Professional | TC | $41.69 | $53.70 | $79.43 |