- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $47.86 / $56.23
| Facility | 26 | $15.14 | $47.86 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $43.65 / $114.82
| Professional | | $33.11 | $43.65 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $15.85 / $38.02
| Professional | 26 | $9.33 | $15.85 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $75.86
| Professional | TC | $21.88 | $30.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $52.48 / $93.33
| Professional | | $33.11 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $26.92
| Professional | 26 | $10.96 | $15.14 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $38.02 / $64.57
| Professional | TC | $21.88 | $38.02 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $107.15
| Professional | | $40.74 | $63.10 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $17.38 / $28.18
| Professional | 26 | $12.88 | $17.38 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $44.67 / $93.33
| Professional | TC | $26.92 | $44.67 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $48.98 / $67.61
| Professional | | $39.81 | $48.98 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $15.85 / $19.05
| Professional | 26 | $13.18 | $15.85 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $42.66 / $54.95
| Professional | TC | $32.36 | $42.66 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $19.50 / $70.79
| Professional | | $16.60 | $19.50 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $56.23 / $109.65
| Professional | | $36.31 | $56.23 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $15.14 / $39.81
| Professional | 26 | $10.23 | $15.14 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $39.81 / $77.62
| Professional | TC | $25.12 | $39.81 | $77.62 |