- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.48 / $15.85
| Facility | 26 | $7.94 | $11.48 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $75.86
| Professional | | $25.12 | $36.31 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.91 / $20.89
| Professional | 26 | $7.08 | $8.91 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $27.54 / $54.95
| Professional | TC | $19.05 | $27.54 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $30.20 / $52.48
| Professional | | $27.54 | $30.20 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $9.77 / $17.38
| Professional | 26 | $9.55 | $9.77 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $20.42 / $36.31
| Professional | TC | $17.78 | $20.42 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $10.96 / $12.88
| Professional | | $8.13 | $10.96 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.14 / $10.00 / $14.13
| Facility | 26 | $2.14 | $10.00 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $50.12 / $181.97
| Professional | | $28.84 | $50.12 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $13.80 / $43.65
| Professional | 26 | $8.32 | $13.80 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $36.31 / $141.25
| Professional | TC | $20.42 | $36.31 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $32.36 / $33.11
| Professional | | $8.32 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $33.11 / $60.26
| Professional | | $26.92 | $33.11 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $9.55 / $16.60
| Professional | 26 | $7.94 | $9.55 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $23.99 / $41.69
| Professional | TC | $17.78 | $23.99 | $41.69 |