- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $15.85 / $18.20
| Facility | 26 | $13.18 | $15.85 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $269.15
| Professional | | $41.69 | $61.66 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $26.92 / $50.12
| Professional | 26 | $12.88 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $42.66 / $81.28
| Professional | TC | $28.84 | $42.66 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $52.48 / $58.88
| Professional | | $16.60 | $52.48 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $15.49 / $16.98
| Professional | 26 | $14.45 | $15.49 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $42.66 / $47.86
| Professional | TC | $36.31 | $42.66 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Facility | 26 | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $57.54 / $104.71
| Professional | | $40.74 | $57.54 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $17.38 / $32.36
| Professional | 26 | $11.75 | $17.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $41.69 / $77.62
| Professional | TC | $28.84 | $41.69 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $61.66 / $83.18
| Professional | | $54.95 | $61.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $17.38 / $23.44
| Professional | 26 | $15.49 | $17.38 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $44.67 / $60.26
| Professional | TC | $38.90 | $44.67 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $56.23 / $112.20
| Professional | | $41.69 | $56.23 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $16.98 / $33.88
| Professional | 26 | $12.02 | $16.98 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $37.15 / $67.61
| Professional | TC | $28.84 | $37.15 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $85.11
| Professional | | $40.74 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $16.22 / $23.44
| Professional | 26 | $11.75 | $16.22 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $42.66 / $61.66
| Professional | TC | $28.84 | $42.66 | $61.66 |