- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $39.81 / $70.79
| Facility | 26 | $11.48 | $39.81 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $37.15 / $169.82
| Professional | | $21.88 | $37.15 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $10.23 / $33.11
| Professional | 26 | $8.71 | $10.23 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $20.89 / $120.23
| Professional | TC | $12.88 | $20.89 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Professional | | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $9.12 / $17.78
| Professional | 26 | $7.24 | $9.12 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $60.26
| Professional | | $27.54 | $27.54 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $21.38
| Professional | 26 | $11.22 | $11.22 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $7.08
| Facility | 26 | $7.08 | $7.08 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $43.65 / $147.91
| Professional | | $19.95 | $43.65 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $12.02 / $19.95
| Professional | 26 | $7.08 | $12.02 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $25.70 / $138.04
| Professional | TC | $11.22 | $25.70 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $36.31 / $42.66
| Professional | | $25.70 | $36.31 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $12.59 / $15.14
| Professional | 26 | $9.33 | $12.59 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $23.44 / $28.18
| Professional | TC | $16.60 | $23.44 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $23.44 / $46.77
| Professional | | $19.05 | $23.44 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $9.55 / $15.14
| Professional | 26 | $8.13 | $9.55 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $13.80 / $31.62
| Professional | TC | $11.75 | $13.80 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $123.03
| Professional | | $19.95 | $33.11 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $11.22 / $19.95
| Professional | 26 | $7.59 | $11.22 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $19.50 / $104.71
| Professional | TC | $12.02 | $19.50 | $104.71 |