- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.30 / $17.78
| Facility | 26 | $8.91 | $12.30 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $30.20 / $58.88
| Professional | | $22.91 | $30.20 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $9.12 / $21.38
| Professional | 26 | $7.08 | $9.12 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $20.89 / $40.74
| Professional | TC | $14.79 | $20.89 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $26.30
| Professional | | $24.55 | $24.55 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $29.51 / $57.54
| Professional | | $28.84 | $29.51 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.23 / $19.05
| Professional | 26 | $10.00 | $10.23 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $19.50 / $38.02
| Professional | TC | $18.62 | $19.50 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $11.75 / $14.45
| Professional | | $8.91 | $11.75 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.34 / $10.96 / $15.85
| Facility | 26 | $2.34 | $10.96 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $45.71 / $151.36
| Professional | | $27.54 | $45.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $15.49 / $45.71
| Professional | 26 | $8.71 | $15.49 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $33.88 / $104.71
| Professional | TC | $18.62 | $33.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $32.36 / $33.11
| Professional | | $16.98 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $51.29
| Professional | | $26.30 | $32.36 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $10.23 / $17.78
| Professional | 26 | $8.71 | $10.23 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $21.38 / $36.31
| Professional | TC | $17.78 | $21.38 | $36.31 |