- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $13.80
| Facility | 26 | $13.80 | $13.80 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $81.28
| Professional | | $28.18 | $39.81 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.02 / $29.51
| Professional | 26 | $7.94 | $12.02 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $25.70 / $53.70
| Professional | TC | $16.98 | $25.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $66.07
| Professional | | $30.90 | $48.98 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $14.13 / $19.95
| Professional | 26 | $8.71 | $14.13 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $46.77
| Professional | TC | $22.91 | $33.88 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $48.98 / $87.10
| Professional | | $34.67 | $48.98 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $15.49 / $28.18
| Professional | 26 | $10.23 | $15.49 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $61.66
| Professional | TC | $22.91 | $33.88 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $56.23 / $104.71
| Professional | | $38.90 | $56.23 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.14 / $28.84
| Professional | 26 | $12.02 | $15.14 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $70.79
| Professional | TC | $30.20 | $38.02 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | 26 | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $42.66 / $79.43
| Professional | | $32.36 | $42.66 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $13.18 / $23.99
| Professional | 26 | $9.77 | $13.18 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $29.51 / $56.23
| Professional | TC | $21.38 | $29.51 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $50.12 / $95.50
| Professional | | $34.67 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $16.60 / $70.79
| Professional | 26 | $10.72 | $16.60 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $31.62 / $58.88
| Professional | TC | $23.44 | $31.62 | $58.88 |