- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.39 / $4.07 / $5.25
| Facility | 26 | $3.39 | $4.07 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $128.82
| Professional | | $21.88 | $35.48 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.88 / $4.27 / $11.22
| Professional | 26 | $2.88 | $4.27 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $24.55 / $61.66
| Professional | TC | $19.05 | $24.55 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $26.92 / $43.65
| Professional | | $16.60 | $26.92 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.29 / $3.63 / $4.90
| Professional | 26 | $2.29 | $3.63 | $4.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $26.30
| Professional | TC | $24.55 | $24.55 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $67.61 / $123.03
| Professional | | $20.42 | $67.61 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.47 / $7.08 / $10.72
| Professional | 26 | $3.47 | $7.08 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $60.26 / $112.20
| Professional | TC | $16.22 | $60.26 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.09 / $19.95 / $27.54
| Professional | | $3.09 | $19.95 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $45.71 / $181.97
| Professional | | $23.44 | $45.71 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $4.68 / $7.76
| Professional | 26 | $3.09 | $4.68 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $38.90 / $144.54
| Professional | TC | $19.50 | $38.90 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $117.49
| Professional | | $21.88 | $32.36 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.82 / $4.07 / $6.92
| Professional | 26 | $2.82 | $4.07 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $27.54 / $114.82
| Professional | TC | $18.62 | $27.54 | $114.82 |