- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.88
| Facility | 26 | $21.38 | $21.38 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $114.82
| Professional | | $30.20 | $40.74 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $34.67
| Professional | 26 | $10.96 | $15.14 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $34.67
| Professional | TC | $19.05 | $25.12 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $36.31 / $40.74
| Professional | | $30.90 | $36.31 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $12.88 / $14.13
| Professional | 26 | $10.96 | $12.88 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $26.92 / $42.66
| Professional | | $10.00 | $26.92 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $53.70 / $69.18
| Professional | | $40.74 | $53.70 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $20.42 / $26.92
| Professional | 26 | $15.49 | $20.42 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $32.36 / $42.66
| Professional | TC | $25.12 | $32.36 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $33.11 / $53.70
| Professional | | $26.92 | $33.11 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $87.10
| Professional | | $41.69 | $57.54 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $20.89 / $27.54
| Professional | 26 | $15.85 | $20.89 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $33.88 / $42.66
| Professional | TC | $25.70 | $33.88 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $54.95 / $81.28
| Professional | | $39.81 | $54.95 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $20.89 / $30.90
| Professional | 26 | $14.45 | $20.89 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $33.88 / $50.12
| Professional | TC | $24.55 | $33.88 | $50.12 |