- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $51.29 / $72.44
| Facility | 26 | $16.60 | $51.29 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $93.33 / $131.83
| Facility | TC | $61.66 | $93.33 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $46.77 / $125.89
| Professional | | $32.36 | $46.77 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $16.98 / $46.77
| Professional | 26 | $10.47 | $16.98 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $28.18 / $66.07
| Professional | TC | $20.89 | $28.18 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $63.10 / $107.15
| Professional | | $28.18 | $63.10 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $18.62 / $38.02
| Professional | 26 | $7.94 | $18.62 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $44.67 / $69.18
| Professional | TC | $20.42 | $44.67 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $61.66 / $97.72
| Professional | | $42.66 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $19.05 / $33.11
| Professional | 26 | $14.13 | $19.05 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $42.66 / $70.79
| Professional | TC | $27.54 | $42.66 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $66.07
| Professional | | $37.15 | $50.12 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $16.98 / $20.89
| Professional | 26 | $14.45 | $16.98 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $51.29
| Professional | TC | $28.18 | $40.74 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $21.38 / $83.18
| Professional | | $18.20 | $21.38 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $54.95 / $114.82
| Professional | | $35.48 | $54.95 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $16.60 / $43.65
| Professional | 26 | $11.22 | $16.60 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $38.90 / $85.11
| Professional | TC | $23.99 | $38.90 | $85.11 |