- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $14.45 / $16.98
| Facility | 26 | $11.22 | $14.45 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $323.59
| Professional | | $21.88 | $35.48 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $10.23 / $54.95
| Professional | 26 | $8.91 | $10.23 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $16.98 / $190.55
| Professional | TC | $12.88 | $16.98 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $22.39 / $44.67
| Professional | | $19.05 | $22.39 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $9.33 / $17.38
| Professional | 26 | $6.92 | $9.33 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $56.23 / $97.72
| Professional | | $28.84 | $56.23 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.13 / $9.12 / $16.22
| Professional | 26 | $5.13 | $9.12 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $46.77 / $81.28
| Professional | TC | $21.38 | $46.77 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $18.20 / $31.62
| Professional | | $9.55 | $18.20 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $45.71 / $169.82
| Professional | | $20.89 | $45.71 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.59 / $21.88
| Professional | 26 | $7.94 | $12.59 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $30.20 / $154.88
| Professional | TC | $12.88 | $30.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $34.67 / $131.83
| Professional | | $20.89 | $34.67 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $10.96 / $25.70
| Professional | 26 | $8.51 | $10.96 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $18.62 / $120.23
| Professional | TC | $11.75 | $18.62 | $120.23 |