- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $14.45 / $14.45
| Facility | 26 | $9.77 | $14.45 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $48.98 / $117.49
| Professional | | $28.84 | $48.98 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $16.98 / $31.62
| Professional | 26 | $8.51 | $16.98 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $66.07
| Professional | TC | $19.95 | $30.90 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $44.67 / $47.86
| Professional | | $29.51 | $44.67 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.96 / $13.49
| Professional | 26 | $7.94 | $10.96 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $23.44 / $33.11
| Professional | TC | $16.98 | $23.44 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $48.98 / $63.10
| Professional | | $34.67 | $48.98 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $15.49 / $19.95
| Professional | 26 | $10.72 | $15.49 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $33.88 / $42.66
| Professional | TC | $23.44 | $33.88 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $10.72
| Facility | 26 | $10.47 | $10.47 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $83.18
| Professional | | $25.70 | $38.90 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $12.59 / $26.92
| Professional | 26 | $8.51 | $12.59 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $30.20 / $66.07
| Professional | TC | $20.42 | $30.20 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $36.31 / $67.61
| Professional | | $25.70 | $36.31 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $11.48 / $56.23
| Professional | 26 | $7.94 | $11.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $25.12 / $46.77
| Professional | TC | $17.78 | $25.12 | $46.77 |