- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $20.42 / $20.42
| Facility | 26 | $14.13 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $53.70 / $109.65
| Professional | | $34.67 | $53.70 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $24.55 / $48.98
| Professional | 26 | $12.88 | $24.55 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $36.31 / $69.18
| Professional | TC | $23.99 | $36.31 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $35.48 / $39.81
| Professional | | $29.51 | $35.48 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $17.78 / $22.91
| Professional | 26 | $11.48 | $17.78 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $33.11
| Professional | TC | $19.95 | $30.90 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $81.28 / $104.71
| Professional | | $57.54 | $81.28 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $42.66
| Professional | 26 | $22.91 | $33.11 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $48.98 / $63.10
| Professional | TC | $34.67 | $48.98 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $17.78
| Facility | 26 | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $53.70 / $104.71
| Professional | | $34.67 | $53.70 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $19.95 / $40.74
| Professional | 26 | $12.88 | $19.95 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $83.18
| Professional | TC | $25.12 | $38.90 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $46.77 / $85.11
| Professional | | $34.67 | $46.77 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $15.85 / $87.10
| Professional | 26 | $12.30 | $15.85 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $30.90 / $43.65
| Professional | TC | $21.38 | $30.90 | $43.65 |