- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $5.50 / $81.28
| Facility | 26 | $5.01 | $5.50 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $31.62 / $77.62
| Professional | | $21.88 | $31.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $8.51 / $22.39
| Professional | 26 | $5.62 | $8.51 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $21.88 / $44.67
| Professional | TC | $15.49 | $21.88 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $25.12 / $34.67
| Professional | | $21.88 | $25.12 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $8.51 / $15.85
| Professional | 26 | $6.46 | $8.51 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $23.44 / $26.92
| Professional | | $19.50 | $23.44 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.04 / $9.55 / $16.22
| Facility | 26 | $2.04 | $9.55 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $30.90 / $64.57
| Professional | | $21.38 | $30.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $9.55 / $19.05
| Professional | 26 | $5.75 | $9.55 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $22.91 / $52.48
| Professional | TC | $15.49 | $22.91 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $9.33
| Facility | 26 | $9.33 | $9.33 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $26.92 / $42.66
| Professional | | $22.39 | $26.92 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $8.13 / $12.02
| Professional | 26 | $5.89 | $8.13 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $30.90
| Professional | TC | $15.14 | $19.05 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $21.88 / $33.88
| Professional | | $5.25 | $21.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $29.51 / $63.10
| Professional | | $22.39 | $29.51 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $8.51 / $18.62
| Professional | 26 | $6.76 | $8.51 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $20.89 / $45.71
| Professional | TC | $15.49 | $20.89 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $34.67
| Professional | | $18.62 | $18.62 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.57 / $4.57 / $8.71
| Professional | 26 | $4.57 | $4.57 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $25.70
| Professional | TC | $13.80 | $13.80 | $25.70 |