- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $15.85 / $15.85
| Facility | 26 | $14.13 | $15.85 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $30.20 / $54.95
| Facility | TC | $26.92 | $30.20 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $40.74 / $69.18
| Professional | | $37.15 | $40.74 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.14 / $26.92
| Professional | 26 | $12.02 | $15.14 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $28.18 / $38.02
| Professional | TC | $23.99 | $28.18 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $16.60
| Professional | | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.63 / $16.98 / $23.99
| Facility | 26 | $3.63 | $16.98 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.24 / $33.88 / $47.86
| Facility | TC | $7.24 | $33.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $60.26 / $213.80
| Professional | | $35.48 | $60.26 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $21.38 / $69.18
| Professional | 26 | $11.75 | $21.38 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $36.31 / $144.54
| Professional | TC | $23.99 | $36.31 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $436.52
| Facility | TC | $288.40 | $288.40 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Professional | 26 | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $47.86 / $83.18
| Professional | | $32.36 | $47.86 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $17.78 / $31.62
| Professional | 26 | $11.48 | $17.78 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $28.84 / $52.48
| Professional | TC | $20.42 | $28.84 | $52.48 |