- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $33.11
| Facility | 26 | $24.55 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.92 / $70.79
| Professional | | $15.85 | $26.92 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $8.91 / $23.99
| Professional | 26 | $5.01 | $8.91 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $17.38 / $46.77
| Professional | TC | $10.96 | $17.38 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.02 / $72.44
| Professional | | $26.30 | $38.02 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $12.88 / $26.92
| Professional | 26 | $8.32 | $12.88 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $23.99 / $46.77
| Professional | TC | $18.20 | $23.99 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $33.11
| Facility | 26 | $24.55 | $24.55 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $61.66 / $104.71
| Professional | | $28.84 | $61.66 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $22.39 / $56.23
| Professional | 26 | $8.91 | $22.39 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $39.81 / $72.44
| Professional | TC | $19.95 | $39.81 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $97.72 / $144.54
| Professional | | $89.13 | $97.72 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $30.90 / $51.29
| Professional | 26 | $27.54 | $30.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $67.61 / $97.72
| Professional | TC | $52.48 | $67.61 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $60.26 / $72.44
| Professional | | $27.54 | $60.26 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $10.47 / $28.18
| Professional | 26 | $6.46 | $10.47 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $20.42 / $46.77
| Professional | TC | $14.45 | $20.42 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $58.88 / $125.89
| Professional | | $28.84 | $58.88 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $22.39 / $48.98
| Professional | 26 | $8.71 | $22.39 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $36.31 / $77.62
| Professional | TC | $19.50 | $36.31 | $77.62 |