- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $15.85 / $22.91
| Facility | 26 | $12.59 | $15.85 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $63.10 / $144.54
| Professional | | $48.98 | $63.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $19.05 / $45.71
| Professional | 26 | $10.96 | $19.05 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $45.71 / $81.28
| Professional | TC | $37.15 | $45.71 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $109.65
| Professional | | $53.70 | $72.44 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $15.49 / $22.91
| Professional | 26 | $11.48 | $15.49 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $56.23 / $87.10
| Professional | TC | $41.69 | $56.23 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $74.13 / $107.15
| Professional | | $57.54 | $74.13 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $16.60 / $24.55
| Professional | 26 | $12.59 | $16.60 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $58.88 / $85.11
| Professional | TC | $44.67 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $128.82
| Professional | | $61.66 | $95.50 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $17.38 / $29.51
| Professional | 26 | $11.22 | $17.38 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $77.62 / $97.72
| Professional | TC | $50.12 | $77.62 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $67.61 / $91.20
| Professional | | $53.70 | $67.61 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $12.30 / $20.42
| Professional | 26 | $11.48 | $12.30 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $54.95 / $70.79
| Professional | TC | $41.69 | $54.95 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $109.65
| Professional | | $54.95 | $75.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $19.05 / $30.20
| Professional | 26 | $12.88 | $19.05 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $57.54 / $81.28
| Professional | TC | $42.66 | $57.54 | $81.28 |