- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $38.02 / $63.10
| Facility | 26 | $7.94 | $38.02 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $18.20 / $74.13
| Professional | | $15.14 | $18.20 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $14.13 / $33.88
| Professional | 26 | $7.94 | $14.13 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.03 / $7.94 / $23.44
| Professional | TC | $6.03 | $7.94 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $19.05 / $109.65
| Professional | | $10.00 | $19.05 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $12.02
| Professional | 26 | $9.55 | $9.55 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $10.47
| Professional | TC | $9.33 | $9.33 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $29.51 / $51.29
| Professional | | $16.22 | $29.51 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $12.30 / $25.12
| Professional | 26 | $8.32 | $12.30 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.41 / $13.80 / $26.30
| Professional | TC | $7.41 | $13.80 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $22.39 / $42.66
| Professional | | $19.05 | $22.39 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $10.96 / $21.38
| Professional | 26 | $9.33 | $10.96 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.77 / $11.48 / $20.89
| Professional | TC | $9.77 | $11.48 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $26.92 / $109.65
| Professional | | $17.38 | $26.92 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $28.18 / $66.07
| Professional | 26 | $9.33 | $28.18 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.51 / $13.18 / $58.88
| Professional | TC | $8.51 | $13.18 | $58.88 |