- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $12.30 / $24.55
| Facility | 26 | $10.47 | $12.30 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $46.77 / $107.15
| Professional | | $32.36 | $46.77 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $14.45 / $32.36
| Professional | 26 | $7.76 | $14.45 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $30.20 / $81.28
| Professional | TC | $19.95 | $30.20 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $14.79
| Professional | 26 | $12.88 | $12.88 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $54.95 / $70.79
| Professional | | $47.86 | $54.95 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $19.05 / $24.55
| Professional | 26 | $16.60 | $19.05 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $35.48 / $45.71
| Professional | TC | $30.90 | $35.48 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $33.88 / $63.10
| Professional | | $16.22 | $33.88 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.63 / $16.98 / $24.55
| Facility | 26 | $3.63 | $16.98 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $67.61 / $107.15
| Professional | | $38.90 | $67.61 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $13.49 / $26.92
| Professional | 26 | $8.32 | $13.49 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $47.86 / $95.50
| Professional | TC | $25.70 | $47.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $31.62 / $31.62
| Professional | 26 | $28.18 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $63.10 / $102.33
| Professional | | $38.02 | $63.10 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $15.49 / $29.51
| Professional | 26 | $8.32 | $15.49 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $42.66 / $83.18
| Professional | TC | $23.99 | $42.66 | $83.18 |