- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $17.78 / $17.78
| Facility | 26 | $12.30 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $67.61 / $138.04
| Professional | | $41.69 | $67.61 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $23.99 / $52.48
| Professional | 26 | $11.22 | $23.99 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $89.13
| Professional | TC | $30.90 | $48.98 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $42.66 / $63.10
| Professional | | $34.67 | $42.66 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $14.45 / $16.60
| Professional | 26 | $9.77 | $14.45 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $38.02
| Professional | TC | $25.12 | $34.67 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $95.50
| Professional | | $52.48 | $74.13 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $25.12 / $32.36
| Professional | 26 | $17.38 | $25.12 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $48.98 / $63.10
| Professional | TC | $34.67 | $48.98 | $63.10 |
- 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
- $35.48 / $56.23 / $109.65
| Professional | | $35.48 | $56.23 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $19.05 / $33.88
| Professional | 26 | $11.22 | $19.05 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $89.13
| Professional | TC | $28.18 | $40.74 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $93.33
| Professional | | $37.15 | $48.98 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $14.13 / $81.28
| Professional | 26 | $11.22 | $14.13 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $35.48 / $66.07
| Professional | TC | $25.70 | $35.48 | $66.07 |