- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $16.98 / $21.88
| Facility | 26 | $15.14 | $16.98 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $64.57 / $151.36
| Professional | | $41.69 | $64.57 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $17.78 / $45.71
| Professional | 26 | $10.96 | $17.78 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $41.69 / $77.62
| Professional | TC | $30.20 | $41.69 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $42.66 / $61.66
| Professional | | $34.67 | $42.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $12.30 / $14.79
| Professional | 26 | $10.23 | $12.30 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $36.31 / $50.12
| Professional | TC | $30.90 | $36.31 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $77.62
| Professional | | $54.95 | $64.57 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $17.78 / $25.70
| Professional | 26 | $14.13 | $17.78 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $48.98 / $54.95
| Professional | TC | $41.69 | $48.98 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $30.90 / $30.90
| Professional | 26 | $12.30 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $50.12 / $97.72
| Professional | | $31.62 | $50.12 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $15.85 / $29.51
| Professional | 26 | $9.12 | $15.85 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $37.15 / $67.61
| Professional | TC | $23.44 | $37.15 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $51.29 / $79.43
| Professional | | $36.31 | $51.29 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $14.13 / $23.44
| Professional | 26 | $11.22 | $14.13 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $36.31 / $54.95
| Professional | TC | $24.55 | $36.31 | $54.95 |