- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $12.59 / $251.19
| Facility | 26 | $9.77 | $12.59 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $61.66 / $151.36
| Professional | | $35.48 | $61.66 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $125.89
| Professional | 25 | $91.20 | $91.20 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $14.13 / $32.36
| Professional | 26 | $9.55 | $14.13 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $69.18
| Professional | TC | $25.70 | $38.90 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $43.65 / $70.79
| Professional | | $33.11 | $43.65 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $11.48 / $14.79
| Professional | 26 | $9.55 | $11.48 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Professional | TC | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $83.18 / $107.15
| Professional | | $41.69 | $83.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $22.91 / $26.92
| Professional | 26 | $11.48 | $22.91 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $60.26 / $70.79
| Professional | TC | $30.20 | $60.26 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $69.18 / $120.23
| Professional | | $42.66 | $69.18 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $17.78 / $28.18
| Professional | 26 | $10.96 | $17.78 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $53.70 / $93.33
| Professional | TC | $32.36 | $53.70 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $85.11
| Professional | | $41.69 | $57.54 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $13.49 / $21.88
| Professional | 26 | $9.33 | $13.49 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $44.67 / $63.10
| Professional | TC | $30.90 | $44.67 | $63.10 |