- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $20.42 / $79.43
| Facility | 26 | $15.14 | $20.42 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $75.86 / $257.04
| Professional | | $34.67 | $75.86 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $31.62 / $69.18
| Professional | 26 | $16.22 | $31.62 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $28.18 / $70.79
| Professional | TC | $15.14 | $28.18 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $66.07
| Professional | | $32.36 | $40.74 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $22.91 / $45.71
| Professional | 26 | $17.78 | $22.91 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.47 / $20.89 / $25.12
| Professional | TC | $10.47 | $20.89 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $28.84 / $67.61
| Professional | | $22.39 | $28.84 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $30.90 / $74.13
| Facility | 26 | $5.75 | $30.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $64.57 / $144.54
| Professional | | $33.88 | $64.57 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $22.39 / $50.12
| Professional | 26 | $15.49 | $22.39 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $34.67 / $97.72
| Professional | TC | $16.98 | $34.67 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Facility | 26 | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $54.95 / $81.28
| Professional | | $37.15 | $54.95 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $20.42 / $34.67
| Professional | 26 | $14.79 | $20.42 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $31.62 / $64.57
| Professional | TC | $18.62 | $31.62 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $32.36 / $45.71
| Professional | | $18.62 | $32.36 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $64.57 / $117.49
| Professional | | $38.02 | $64.57 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $20.89 / $58.88
| Professional | 26 | $15.49 | $20.89 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $29.51 / $81.28
| Professional | TC | $18.20 | $29.51 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $52.48
| Professional | | $38.02 | $38.02 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $24.55
| Professional | 26 | $17.78 | $17.78 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $28.18
| Professional | TC | $20.42 | $20.42 | $28.18 |