- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $9.77 / $16.22
| Facility | 26 | $9.33 | $9.77 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $109.65
| Professional | | $22.91 | $33.11 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $9.33 / $28.84
| Professional | 26 | $6.17 | $9.33 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $20.89 / $35.48
| Professional | TC | $15.14 | $20.89 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $23.44 / $24.55
| Professional | | $19.50 | $23.44 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $6.76 / $7.76
| Professional | 26 | $5.75 | $6.76 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $36.31
| Professional | | $27.54 | $27.54 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $10.72
| Professional | 26 | $8.13 | $8.13 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $25.70
| Professional | TC | $19.50 | $19.50 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $20.89 / $35.48
| Professional | | $7.41 | $20.89 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.74 / $8.13 / $11.48
| Facility | 26 | $1.74 | $8.13 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $39.81 / $75.86
| Professional | | $24.55 | $39.81 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.47 / $14.79
| Professional | 26 | $7.08 | $10.47 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $27.54 / $53.70
| Professional | TC | $17.38 | $27.54 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.59 / $18.62
| Professional | 26 | $10.00 | $12.59 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $33.11 / $66.07
| Professional | | $23.99 | $33.11 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $8.71 / $15.14
| Professional | 26 | $6.76 | $8.71 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $22.91 / $48.98
| Professional | TC | $16.98 | $22.91 | $48.98 |