- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $58.88 / $58.88
| Facility | 26 | $22.39 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $44.67 / $114.82
| Professional | | $28.84 | $44.67 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.14 / $42.66
| Professional | 26 | $12.02 | $15.14 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $26.92 / $52.48
| Professional | TC | $16.98 | $26.92 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $64.57 / $95.50
| Professional | | $41.69 | $64.57 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $23.44 / $33.88
| Professional | 26 | $15.14 | $23.44 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $40.74 / $58.88
| Professional | TC | $26.92 | $40.74 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $74.13 / $141.25
| Professional | | $42.66 | $74.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $25.12 / $41.69
| Professional | 26 | $16.98 | $25.12 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $52.48 / $93.33
| Professional | TC | $26.30 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $69.18 / $112.20
| Professional | | $33.88 | $69.18 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $39.81
| Professional | 26 | $17.38 | $24.55 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $47.86 / $72.44
| Professional | TC | $30.90 | $47.86 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $70.79 / $144.54
| Professional | | $47.86 | $70.79 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $23.44 / $45.71
| Professional | 26 | $16.60 | $23.44 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $43.65 / $74.13
| Professional | TC | $30.20 | $43.65 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $12.30 / $14.79
| Facility | 26 | $11.22 | $12.30 | $14.79 |