- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $13.49 / $14.79
| Facility | 26 | $12.88 | $13.49 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $47.86 / $109.65
| Professional | | $38.02 | $47.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $13.49 / $29.51
| Professional | 26 | $10.00 | $13.49 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $58.88
| Professional | TC | $25.70 | $32.36 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $52.48 / $72.44
| Professional | | $39.81 | $52.48 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $14.13 / $17.38
| Professional | 26 | $12.88 | $14.13 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $79.43
| Professional | TC | $39.81 | $39.81 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $54.95 / $93.33
| Professional | | $41.69 | $54.95 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $14.45 / $23.99
| Professional | 26 | $10.96 | $14.45 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $39.81 / $67.61
| Professional | TC | $30.20 | $39.81 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $57.54 / $75.86
| Professional | | $44.67 | $57.54 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $13.18 / $18.62
| Professional | 26 | $10.47 | $13.18 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $44.67 / $58.88
| Professional | TC | $34.67 | $44.67 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $51.29 / $87.10
| Professional | | $37.15 | $51.29 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $13.80 / $23.44
| Professional | 26 | $10.00 | $13.80 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $37.15 / $63.10
| Professional | TC | $26.92 | $37.15 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $75.86
| Professional | | $38.02 | $57.54 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $13.18 / $17.78
| Professional | 26 | $9.55 | $13.18 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $57.54
| Professional | TC | $28.18 | $44.67 | $57.54 |