- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $6.61 / $9.33
| Facility | 26 | $6.61 | $6.61 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $72.44
| Professional | | $19.95 | $30.90 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.23 / $21.38
| Professional | 26 | $6.03 | $10.23 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $18.20 / $38.90
| Professional | TC | $12.88 | $18.20 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $24.55 / $28.18
| Professional | | $15.49 | $24.55 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $7.76 / $8.91
| Professional | 26 | $7.24 | $7.76 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $17.38 / $21.88
| Professional | TC | $15.85 | $17.38 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.59
| Facility | 26 | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $26.30 / $50.12
| Professional | | $19.05 | $26.30 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $8.32 / $15.49
| Professional | 26 | $5.75 | $8.32 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.18 / $18.62 / $33.11
| Professional | TC | $13.18 | $18.62 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $28.18 / $38.90
| Professional | | $25.12 | $28.18 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $8.71 / $12.02
| Professional | 26 | $7.94 | $8.71 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $19.50 / $26.92
| Professional | TC | $16.98 | $19.50 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $45.71
| Professional | | $19.05 | $25.12 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $8.51 / $17.38
| Professional | 26 | $6.03 | $8.51 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.18 / $16.98 / $30.90
| Professional | TC | $13.18 | $16.98 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $27.54 / $39.81
| Professional | | $18.62 | $27.54 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $8.32 / $11.75
| Professional | 26 | $5.75 | $8.32 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $19.05 / $27.54
| Professional | TC | $12.88 | $19.05 | $27.54 |