- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $16.22 / $40.74
| Facility | 26 | $11.48 | $16.22 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $275.42
| Facility | TC | $25.12 | $41.69 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $41.69 / $104.71
| Professional | | $32.36 | $41.69 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $38.90
| Professional | 26 | $10.96 | $15.14 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $58.88
| Professional | TC | $20.89 | $26.92 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $30.90
| Professional | | $28.18 | $28.18 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $40.74
| Professional | 26 | $19.95 | $30.90 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $53.70 / $79.43
| Professional | TC | $37.15 | $53.70 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $60.26 / $107.15
| Professional | | $33.88 | $60.26 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $20.42 / $36.31
| Professional | 26 | $11.22 | $20.42 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $38.90 / $70.79
| Professional | TC | $22.91 | $38.90 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $38.02 / $74.13
| Professional | | $13.18 | $38.02 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $50.12 / $95.50
| Professional | | $36.31 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $18.20 / $37.15
| Professional | 26 | $12.88 | $18.20 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $31.62 / $57.54
| Professional | TC | $23.44 | $31.62 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Facility | 26 | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Facility | TC | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $354.81
| Professional | | $269.15 | $269.15 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $104.71
| Professional | 26 | $81.28 | $81.28 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $245.47
| Professional | TC | $190.55 | $190.55 | $245.47 |