- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $11.22 / $12.59
| Facility | 26 | $9.12 | $11.22 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $52.48 / $169.82
| Professional | | $32.36 | $52.48 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $17.78 / $33.88
| Professional | 26 | $8.91 | $17.78 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $37.15 / $83.18
| Professional | TC | $21.88 | $37.15 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $38.02 / $44.67
| Professional | | $11.22 | $38.02 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $10.23 / $11.48
| Professional | 26 | $9.55 | $10.23 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $29.51 / $34.67
| Professional | TC | $24.55 | $29.51 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Facility | 26 | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $39.81 / $75.86
| Professional | | $28.84 | $39.81 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $10.72 / $20.89
| Professional | 26 | $7.59 | $10.72 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $29.51 / $56.23
| Professional | TC | $21.88 | $29.51 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $45.71 / $61.66
| Professional | | $38.90 | $45.71 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $11.75 / $16.22
| Professional | 26 | $10.23 | $11.75 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $33.88 / $45.71
| Professional | TC | $28.84 | $33.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $83.18
| Professional | | $28.18 | $39.81 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $11.48 / $22.91
| Professional | 26 | $7.59 | $11.48 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $60.26
| Professional | TC | $20.89 | $28.84 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $64.57
| Professional | | $27.54 | $44.67 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $11.22 / $16.22
| Professional | 26 | $7.24 | $11.22 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $47.86
| Professional | TC | $19.95 | $33.11 | $47.86 |