- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $12.30
| Facility | 26 | $6.03 | $6.03 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $24.55 / $177.83
| Facility | TC | $15.14 | $24.55 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $63.10
| Professional | | $20.89 | $30.20 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $7.94 / $17.78
| Professional | 26 | $6.03 | $7.94 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $20.89 / $33.11
| Professional | TC | $15.14 | $20.89 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Professional | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $26.92 / $37.15
| Professional | | $8.13 | $26.92 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.59
| Facility | 26 | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Facility | TC | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $26.30 / $40.74
| Professional | | $20.42 | $26.30 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $8.51 / $13.18
| Professional | 26 | $6.61 | $8.51 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $18.62 / $28.84
| Professional | TC | $13.80 | $18.62 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $70.79 / $70.79
| Facility | 26 | $18.62 | $70.79 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $97.72 / $97.72
| Facility | TC | $45.71 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $29.51 / $186.21
| Professional | | $24.55 | $29.51 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $9.12 / $51.29
| Professional | 26 | $7.41 | $9.12 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $20.42 / $134.90
| Professional | TC | $16.60 | $20.42 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $28.18 / $41.69
| Professional | | $23.44 | $28.18 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $8.51 / $14.13
| Professional | 26 | $7.41 | $8.51 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $19.95 / $28.84
| Professional | TC | $16.22 | $19.95 | $28.84 |