- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $25.70 / $30.20
| Facility | 26 | $7.94 | $25.70 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $75.86 / $245.47
| Facility | TC | $46.77 | $75.86 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $37.15 / $131.83
| Professional | | $13.49 | $37.15 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $10.96 / $29.51
| Professional | 26 | $5.01 | $10.96 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $26.30 / $67.61
| Professional | TC | $17.38 | $26.30 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $61.66
| Professional | | $25.12 | $38.90 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.37 / $8.32 / $15.14
| Professional | 26 | $5.37 | $8.32 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $48.98
| Professional | TC | $19.05 | $30.20 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $42.66 / $75.86
| Professional | | $26.92 | $42.66 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $9.12 / $15.14
| Professional | 26 | $6.92 | $9.12 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $33.88 / $66.07
| Professional | TC | $19.05 | $33.88 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.11 / $45.71
| Professional | | $28.18 | $33.11 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $8.71 / $10.47
| Professional | 26 | $5.89 | $8.71 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $30.90 / $38.90
| Professional | TC | $22.91 | $30.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $11.48 / $56.23
| Professional | | $9.12 | $11.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $38.02 / $89.13
| Professional | | $23.99 | $38.02 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $8.32 / $19.50
| Professional | 26 | $5.62 | $8.32 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $30.20 / $75.86
| Professional | TC | $18.20 | $30.20 | $75.86 |