- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $19.50 / $19.50
| Facility | 26 | $19.05 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $45.71 / $93.33
| Professional | | $33.88 | $45.71 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $16.22 / $46.77
| Professional | 26 | $12.88 | $16.22 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $29.51 / $60.26
| Professional | TC | $21.88 | $29.51 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $89.13
| Professional | | $45.71 | $45.71 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Professional | 26 | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.07 / $4.07 / $4.07
| Professional | TC | $4.07 | $4.07 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $69.18 / $74.13
| Professional | | $44.67 | $69.18 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | 26 | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $57.54 / $123.03
| Professional | | $33.88 | $57.54 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $20.89 / $41.69
| Professional | 26 | $13.18 | $20.89 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $37.15 / $81.28
| Professional | TC | $21.38 | $37.15 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $34.67 / $40.74
| Facility | 26 | $14.79 | $34.67 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $97.72
| Professional | | $33.88 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $19.05 / $36.31
| Professional | 26 | $13.80 | $19.05 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $31.62 / $60.26
| Professional | TC | $20.42 | $31.62 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $44.67 / $89.13
| Professional | | $33.11 | $44.67 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $18.62 / $31.62
| Professional | 26 | $13.80 | $18.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $54.95
| Professional | TC | $20.42 | $28.18 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $52.48 / $138.04
| Professional | | $39.81 | $52.48 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $102.33
| Professional | 26 | $15.14 | $19.05 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $52.48
| Professional | TC | $22.91 | $28.84 | $52.48 |