- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $11.48 / $16.60
| Facility | 26 | $10.23 | $11.48 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $158.49
| Professional | | $51.29 | $67.61 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $9.77 / $25.70
| Professional | 26 | $7.94 | $9.77 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $8.32
| Professional | 52 | $8.13 | $8.13 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $52.48 / $91.20
| Professional | TC | $42.66 | $52.48 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $69.18 / $91.20
| Professional | | $51.29 | $69.18 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $13.49 / $14.79
| Professional | 26 | $8.13 | $13.49 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $61.66 / $74.13
| Professional | | $51.29 | $61.66 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $10.47 / $12.30
| Professional | 26 | $9.12 | $10.47 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $51.29 / $61.66
| Professional | TC | $41.69 | $51.29 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $9.12 / $9.33
| Professional | 26 | $9.12 | $9.12 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $123.03
| Professional | | $51.29 | $67.61 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $11.48 / $20.42
| Professional | 26 | $8.51 | $11.48 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $56.23 / $102.33
| Professional | TC | $42.66 | $56.23 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $56.23 / $91.20
| Professional | | $44.67 | $56.23 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $9.12 / $14.45
| Professional | 26 | $7.24 | $9.12 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $46.77 / $74.13
| Professional | TC | $36.31 | $46.77 | $74.13 |