- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $19.05 / $25.70
| Facility | 26 | $16.98 | $19.05 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $53.70 / $89.13
| Professional | | $36.31 | $53.70 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $18.20 / $45.71
| Professional | 26 | $12.02 | $18.20 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $38.02 / $63.10
| Professional | TC | $24.55 | $38.02 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Professional | | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $14.45 / $21.88
| Professional | 26 | $11.48 | $14.45 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $77.62
| Professional | | $54.95 | $64.57 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $20.89 / $26.30
| Professional | 26 | $16.98 | $20.89 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $44.67 / $52.48
| Professional | TC | $38.02 | $44.67 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $31.62 / $31.62
| Professional | 26 | $14.45 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $53.70 / $95.50
| Professional | | $33.11 | $53.70 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $17.38 / $32.36
| Professional | 26 | $10.23 | $17.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $38.02 / $72.44
| Professional | TC | $21.88 | $38.02 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $52.48 / $81.28
| Professional | | $38.02 | $52.48 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $16.60 / $25.12
| Professional | 26 | $12.88 | $16.60 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $52.48
| Professional | TC | $25.12 | $34.67 | $52.48 |