- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $14.45 / $22.91
| Facility | 26 | $12.02 | $14.45 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $46.77 / $154.88
| Professional | | $33.11 | $46.77 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.98 / $37.15
| Professional | 26 | $10.00 | $16.98 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $61.66
| Professional | TC | $20.89 | $30.20 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $46.77
| Professional | | $39.81 | $39.81 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $12.02 / $14.79
| Professional | 26 | $9.33 | $12.02 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Professional | TC | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.88 / $50.12
| Professional | | $32.36 | $33.88 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.59 / $16.98
| Professional | 26 | $12.02 | $12.59 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $21.38 / $31.62
| Professional | TC | $20.42 | $21.38 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $28.84 / $50.12
| Professional | | $12.59 | $28.84 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $14.13 / $20.42
| Facility | 26 | $3.02 | $14.13 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $56.23 / $199.53
| Professional | | $34.67 | $56.23 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $18.62 / $57.54
| Professional | 26 | $10.96 | $18.62 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $39.81 / $144.54
| Professional | TC | $23.99 | $39.81 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $32.36 / $33.11
| Professional | | $18.20 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $69.18
| Professional | | $34.67 | $41.69 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $14.45 / $24.55
| Professional | 26 | $12.02 | $14.45 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $26.30 / $42.66
| Professional | TC | $22.39 | $26.30 | $42.66 |