- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $12.02 / $25.70
| Facility | 26 | $8.51 | $12.02 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $43.65 / $117.49
| Professional | | $25.70 | $43.65 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $11.48 / $26.92
| Professional | 26 | $7.08 | $11.48 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $28.18 / $52.48
| Professional | TC | $16.98 | $28.18 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $30.90 / $100.00
| Professional | | $19.50 | $30.90 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.23 / $27.54
| Professional | 26 | $7.08 | $10.23 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $53.70 / $79.43
| Professional | | $29.51 | $53.70 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $15.85 / $22.91
| Professional | 26 | $8.32 | $15.85 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $38.02 / $56.23
| Professional | TC | $21.38 | $38.02 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $47.86 / $77.62
| Professional | | $32.36 | $47.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $11.75 / $21.88
| Professional | 26 | $8.91 | $11.75 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $34.67 / $56.23
| Professional | TC | $23.44 | $34.67 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $45.71 / $77.62
| Professional | | $30.20 | $45.71 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $12.88 / $21.38
| Professional | 26 | $9.12 | $12.88 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $35.48 / $56.23
| Professional | TC | $23.44 | $35.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $52.48 / $102.33
| Professional | | $32.36 | $52.48 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $13.49 / $25.70
| Professional | 26 | $9.12 | $13.49 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $38.90 / $72.44
| Professional | TC | $23.44 | $38.90 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.13 / $8.13 / $11.22
| Facility | 26 | $5.13 | $8.13 | $11.22 |