- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $21.88 / $23.44
| Facility | 26 | $8.91 | $21.88 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $67.61 / $181.97
| Professional | | $36.31 | $67.61 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $13.80
| Professional | 25 | $13.80 | $13.80 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $13.80 / $39.81
| Professional | 26 | $9.55 | $13.80 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $40.74 / $91.20
| Professional | TC | $26.30 | $40.74 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $43.65 / $177.83
| Professional | | $10.72 | $43.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $10.72 / $14.79
| Professional | 26 | $9.55 | $10.72 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $33.88 / $45.71
| Professional | TC | $30.20 | $33.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $72.44 / $141.25
| Professional | | $38.90 | $72.44 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $16.60 / $34.67
| Professional | 26 | $9.77 | $16.60 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $56.23 / $109.65
| Professional | TC | $28.18 | $56.23 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $50.12 / $93.33
| Professional | | $46.77 | $50.12 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $11.22 / $22.39
| Professional | 26 | $10.72 | $11.22 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $38.90 / $70.79
| Professional | TC | $35.48 | $38.90 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $61.66 / $120.23
| Professional | | $46.77 | $61.66 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $13.49 / $27.54
| Professional | 26 | $10.23 | $13.49 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $91.20
| Professional | TC | $37.15 | $47.86 | $91.20 |