- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Facility | 26 | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $74.13
| Professional | | $28.18 | $38.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $26.30
| Professional | 26 | $7.94 | $10.00 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $28.18 / $63.10
| Professional | TC | $19.50 | $28.18 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $64.57 / $85.11
| Professional | | $41.69 | $64.57 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $16.22 / $23.44
| Professional | 26 | $10.23 | $16.22 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $47.86 / $63.10
| Professional | TC | $30.90 | $47.86 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $63.10 / $112.20
| Professional | | $42.66 | $63.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $16.98 / $30.20
| Professional | 26 | $11.48 | $16.98 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $47.86 / $93.33
| Professional | TC | $30.20 | $47.86 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $74.13 / $114.82
| Professional | | $48.98 | $74.13 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $18.62 / $27.54
| Professional | 26 | $12.02 | $18.62 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $58.88 / $87.10
| Professional | TC | $36.31 | $58.88 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $60.26 / $147.91
| Professional | | $42.66 | $60.26 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $16.22 / $31.62
| Professional | 26 | $11.48 | $16.22 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $41.69 / $89.13
| Professional | TC | $31.62 | $41.69 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $8.51 / $10.23
| Facility | 26 | $7.76 | $8.51 | $10.23 |