- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $45.71 / $66.07
| Facility | 26 | $8.91 | $45.71 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $91.20
| Professional | | $30.20 | $40.74 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $17.38 / $37.15
| Professional | 26 | $8.91 | $17.38 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $28.18 / $60.26
| Professional | TC | $20.89 | $28.18 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $38.02 / $158.49
| Professional | | $10.96 | $38.02 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $9.77 / $12.02
| Professional | 26 | $9.77 | $9.77 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $31.62
| Professional | TC | $28.18 | $28.18 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $50.12 / $95.50
| Professional | | $31.62 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $13.80 / $27.54
| Professional | 26 | $8.71 | $13.80 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $69.18
| Professional | TC | $21.88 | $33.88 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $43.65 / $89.13
| Professional | | $37.15 | $43.65 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $11.22 / $24.55
| Professional | 26 | $9.55 | $11.22 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $32.36 / $66.07
| Professional | TC | $27.54 | $32.36 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $95.50 / $245.47
| Professional | | $35.48 | $95.50 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $75.86 / $95.50
| Professional | 26 | $10.47 | $75.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $83.18 / $169.82
| Professional | TC | $24.55 | $83.18 | $169.82 |