- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $17.38 / $67.61
| Facility | 26 | $8.91 | $17.38 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $38.90 / $79.43
| Professional | | $30.90 | $38.90 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $23.99
| Professional | 26 | $7.94 | $10.00 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $58.88
| Professional | TC | $21.88 | $28.84 | $58.88 |
- 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
- $9.77 / $13.18 / $20.42
| Professional | 26 | $9.77 | $13.18 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $38.90 / $61.66
| Professional | TC | $26.92 | $38.90 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $46.77 / $117.49
| Professional | | $13.80 | $46.77 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $10.96 / $13.80
| Professional | 26 | $9.77 | $10.96 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $50.12
| Professional | TC | $30.20 | $35.48 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Facility | 26 | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $46.77 / $81.28
| Professional | | $31.62 | $46.77 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $12.88 / $22.91
| Professional | 26 | $8.13 | $12.88 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $63.10
| Professional | TC | $23.44 | $32.36 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $48.98 / $61.66
| Professional | | $40.74 | $48.98 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $11.75 / $15.14
| Professional | 26 | $9.55 | $11.75 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $37.15 / $47.86
| Professional | TC | $30.20 | $37.15 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $61.66 / $89.13
| Professional | | $48.98 | $61.66 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $19.05 / $22.39
| Professional | 26 | $15.49 | $19.05 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $67.61
| Professional | | $39.81 | $39.81 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $42.66 / $104.71
| Professional | | $13.80 | $42.66 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $14.13 / $23.44
| Professional | 26 | $10.72 | $14.13 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $66.07
| Professional | TC | $28.84 | $38.02 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $46.77 / $81.28
| Professional | | $29.51 | $46.77 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $12.88 / $22.91
| Professional | 26 | $8.32 | $12.88 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $57.54
| Professional | TC | $20.89 | $32.36 | $57.54 |