- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $16.98 / $26.92
| Facility | 26 | $13.49 | $16.98 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $70.79 / $177.83
| Professional | | $44.67 | $70.79 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $20.89 / $53.70
| Professional | 26 | $12.02 | $20.89 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $46.77 / $89.13
| Professional | TC | $31.62 | $46.77 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $72.44 / $109.65
| Professional | | $46.77 | $72.44 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $17.38 / $25.70
| Professional | 26 | $13.18 | $17.38 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $53.70 / $83.18
| Professional | TC | $31.62 | $53.70 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Facility | 26 | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $64.57 / $112.20
| Professional | | $44.67 | $64.57 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $18.62 / $33.11
| Professional | 26 | $11.48 | $18.62 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $81.28
| Professional | TC | $30.20 | $44.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $91.20 / $234.42
| Professional | | $69.18 | $91.20 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $20.42 / $72.44
| Professional | 26 | $18.62 | $20.42 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $69.18 / $158.49
| Professional | TC | $63.10 | $69.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $57.54 / $83.18
| Professional | | $51.29 | $57.54 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $13.18 / $20.89
| Professional | 26 | $12.88 | $13.18 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $44.67 / $61.66
| Professional | TC | $38.02 | $44.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $74.13 / $109.65
| Professional | | $50.12 | $74.13 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $22.91 / $40.74
| Professional | 26 | $14.45 | $22.91 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $52.48 / $87.10
| Professional | TC | $35.48 | $52.48 | $87.10 |