- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $16.98 / $16.98
| Facility | 26 | $15.14 | $16.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $46.77 / $75.86
| Professional | | $26.92 | $46.77 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $15.14 / $28.84
| Professional | 26 | $12.88 | $15.14 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.49 / $30.90 / $51.29
| Professional | TC | $13.49 | $30.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $27.54 / $40.74
| Professional | | $23.44 | $27.54 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $15.85 / $21.38
| Professional | 26 | $13.49 | $15.85 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.00 / $11.75 / $18.20
| Professional | TC | $10.00 | $11.75 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $16.22 / $21.38
| Professional | | $12.30 | $16.22 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.55 / $16.60 / $23.44
| Facility | 26 | $3.55 | $16.60 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $47.86 / $208.93
| Professional | | $30.20 | $47.86 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $21.88 / $67.61
| Professional | 26 | $14.45 | $21.88 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.49 / $27.54 / $141.25
| Professional | TC | $13.49 | $27.54 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $70.79
| Professional | | $25.12 | $37.15 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $16.98 / $28.18
| Professional | 26 | $13.49 | $16.98 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $19.50 / $42.66
| Professional | TC | $10.96 | $19.50 | $42.66 |