- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $12.30 / $16.60
| Facility | 26 | $10.96 | $12.30 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $27.54 / $158.49
| Facility | TC | $25.12 | $27.54 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $41.69 / $89.13
| Professional | | $32.36 | $41.69 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $14.13 / $30.20
| Professional | 26 | $10.00 | $14.13 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $28.18 / $54.95
| Professional | TC | $20.89 | $28.18 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $13.49
| Professional | 26 | $9.55 | $9.55 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $48.98
| Professional | | $35.48 | $35.48 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $13.18 / $16.60
| Professional | 26 | $12.88 | $13.18 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $30.90
| Professional | TC | $22.39 | $22.39 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $15.85 / $19.05
| Professional | | $11.75 | $15.85 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $14.45 / $20.89
| Facility | 26 | $3.09 | $14.45 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.92 / $32.36 / $46.77
| Facility | TC | $6.92 | $32.36 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $57.54 / $199.53
| Professional | | $34.67 | $57.54 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $20.42 / $58.88
| Professional | 26 | $11.22 | $20.42 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $39.81 / $141.25
| Professional | TC | $23.44 | $39.81 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $32.36 / $33.11
| Professional | | $18.62 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $69.18
| Professional | | $34.67 | $41.69 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.14 / $25.12
| Professional | 26 | $12.02 | $15.14 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $26.30 / $45.71
| Professional | TC | $22.39 | $26.30 | $45.71 |