- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.59 / $22.91
| Facility | 26 | $12.02 | $12.59 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $81.28 / $169.82
| Professional | | $42.66 | $81.28 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $19.05 / $46.77
| Professional | 26 | $10.96 | $19.05 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $44.67 / $81.28
| Professional | TC | $30.90 | $44.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $43.65 / $60.26
| Professional | | $33.88 | $43.65 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $12.59 / $19.95
| Professional | 26 | $9.55 | $12.59 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $39.81 / $47.86
| Professional | TC | $35.48 | $39.81 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $53.70 / $89.13
| Professional | | $47.86 | $53.70 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $16.60 / $29.51
| Professional | 26 | $15.49 | $16.60 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $35.48 / $61.66
| Professional | TC | $31.62 | $35.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $38.02 / $60.26
| Professional | | $12.88 | $38.02 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $14.45 / $20.89
| Facility | 26 | $3.09 | $14.45 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $74.13 / $245.47
| Professional | | $43.65 | $74.13 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $21.88 / $75.86
| Professional | 26 | $12.30 | $21.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $181.97
| Professional | TC | $32.36 | $57.54 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $32.36 / $38.02
| Professional | | $24.55 | $32.36 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $52.48 / $85.11
| Professional | | $42.66 | $52.48 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $26.92
| Professional | 26 | $12.02 | $15.85 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $35.48 / $58.88
| Professional | TC | $29.51 | $35.48 | $58.88 |