- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $36.31 / $63.10
| Facility | 26 | $10.23 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $72.44
| Professional | | $22.91 | $33.11 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $8.91 / $20.89
| Professional | 26 | $6.03 | $8.91 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $52.48
| Professional | TC | $15.85 | $23.99 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $22.91
| Professional | | $19.50 | $19.50 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $6.17 / $6.17
| Professional | 26 | $6.17 | $6.17 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $5.75
| Facility | 26 | $5.75 | $5.75 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $63.10
| Professional | | $25.12 | $38.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $10.47 / $17.78
| Professional | 26 | $6.46 | $10.47 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $28.18 / $47.86
| Professional | TC | $17.78 | $28.18 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $45.71 / $54.95
| Professional | | $33.11 | $45.71 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $11.48 / $13.80
| Professional | 26 | $8.32 | $11.48 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $41.69
| Professional | TC | $25.12 | $34.67 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $31.62 / $63.10
| Professional | | $26.92 | $31.62 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $8.51 / $16.22
| Professional | 26 | $7.24 | $8.51 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $22.91 / $47.86
| Professional | TC | $19.50 | $22.91 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $34.67 / $61.66
| Professional | | $23.99 | $34.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $9.77 / $16.98
| Professional | 26 | $6.17 | $9.77 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $25.12 / $43.65
| Professional | TC | $17.38 | $25.12 | $43.65 |