- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $14.79 / $14.79
| Facility | 26 | $10.23 | $14.79 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $31.62 / $467.74
| Facility | TC | $28.84 | $31.62 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $45.71 / $91.20
| Professional | | $26.92 | $45.71 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $16.60 / $41.69
| Professional | 26 | $9.55 | $16.60 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $58.88
| Professional | TC | $18.20 | $26.92 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $25.70 / $32.36
| Professional | | $21.88 | $25.70 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $12.30 / $13.18
| Professional | 26 | $8.13 | $12.30 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $23.99 / $29.51
| Professional | TC | $20.89 | $23.99 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $67.61 / $87.10
| Professional | | $47.86 | $67.61 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $25.12 / $32.36
| Professional | 26 | $17.78 | $25.12 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $42.66 / $54.95
| Professional | TC | $29.51 | $42.66 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $77.62
| Professional | | $25.70 | $38.90 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $14.79 / $26.92
| Professional | 26 | $9.12 | $14.79 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $26.30 / $53.70
| Professional | TC | $19.05 | $26.30 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $64.57
| Professional | | $25.70 | $34.67 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $11.75 / $40.74
| Professional | 26 | $9.12 | $11.75 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $23.44 / $42.66
| Professional | TC | $16.60 | $23.44 | $42.66 |