- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.55 / $3.98 / $12.59
| Facility | 26 | $3.55 | $3.98 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $112.20
| Professional | | $20.89 | $32.36 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.80 / $9.55
| Professional | 26 | $2.00 | $3.80 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Professional | 52 | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $23.99 / $50.12
| Professional | TC | $16.98 | $23.99 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $16.60 / $22.39
| Professional | | $14.79 | $16.60 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.29 / $3.31 / $3.80
| Professional | 26 | $2.29 | $3.31 | $3.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $41.69
| Professional | | $28.18 | $33.88 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.89 / $4.57 / $5.75
| Professional | 26 | $3.89 | $4.57 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $36.31
| Professional | TC | $24.55 | $28.84 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $39.81
| Professional | 26 | $3.24 | $3.24 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $32.36 / $123.03
| Professional | | $20.42 | $32.36 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $4.47 / $7.24
| Professional | 26 | $3.09 | $4.47 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $27.54 / $93.33
| Professional | TC | $18.62 | $27.54 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $131.83
| Professional | | $20.89 | $26.92 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.75 / $3.47 / $5.75
| Professional | 26 | $2.75 | $3.47 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $22.39 / $97.72
| Professional | TC | $17.78 | $22.39 | $97.72 |