- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.45 / $3.98 / $3.98
| Facility | 26 | $2.45 | $3.98 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $20.89 / $40.74
| Professional | | $12.88 | $20.89 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.98 / $8.51
| Professional | 26 | $2.00 | $3.98 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $15.85 / $28.84
| Professional | TC | $10.96 | $15.85 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $13.18 / $16.22
| Professional | | $11.75 | $13.18 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.63 / $2.63 / $2.69
| Professional | 26 | $2.63 | $2.63 | $2.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $14.13 / $19.50
| Professional | | $11.22 | $14.13 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.65 / $3.47 / $5.25
| Facility | 26 | $0.65 | $3.47 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $26.92 / $45.71
| Professional | | $14.45 | $26.92 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.75 / $5.89 / $10.23
| Professional | 26 | $2.75 | $5.89 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $20.89 / $36.31
| Professional | TC | $11.75 | $20.89 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $17.78 / $23.44
| Professional | | $11.22 | $17.78 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.00 / $3.39 / $7.08
| Professional | 26 | $2.00 | $3.39 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.51 / $12.02 / $18.62
| Professional | TC | $8.51 | $12.02 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $15.14 / $33.11
| Professional | | $2.51 | $15.14 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $38.02
| Professional | | $15.85 | $22.91 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.31 / $5.13 / $8.51
| Professional | 26 | $3.31 | $5.13 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.30 / $17.78 / $29.51
| Professional | TC | $12.30 | $17.78 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $16.98
| Professional | | $11.48 | $11.48 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.04 / $2.04 / $3.24
| Professional | 26 | $2.04 | $2.04 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $14.13
| Professional | TC | $9.33 | $9.33 | $14.13 |