- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $8.32 / $19.95
| Facility | 26 | $8.32 | $8.32 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $63.10 / $186.21
| Professional | | $48.98 | $63.10 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.02 / $28.18
| Professional | 26 | $7.94 | $12.02 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $50.12 / $109.65
| Professional | TC | $40.74 | $50.12 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Professional | | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $10.72 / $12.88
| Professional | 26 | $8.71 | $10.72 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $112.20 / $162.18
| Professional | | $63.10 | $112.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $16.98 / $25.12
| Professional | 26 | $9.33 | $16.98 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $93.33 / $134.90
| Professional | TC | $53.70 | $93.33 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $81.28 / $154.88
| Professional | | $61.66 | $81.28 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $12.59 / $22.91
| Professional | 26 | $9.55 | $12.59 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $69.18 / $131.83
| Professional | TC | $52.48 | $69.18 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $165.96
| Professional | | $69.18 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $14.79 / $24.55
| Professional | 26 | $10.23 | $14.79 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $87.10 / $141.25
| Professional | TC | $58.88 | $87.10 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $95.50 / $194.98
| Professional | | $63.10 | $95.50 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $14.45 / $29.51
| Professional | 26 | $9.55 | $14.45 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $162.18
| Professional | TC | $52.48 | $79.43 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.07 / $6.46 / $12.02
| Facility | 26 | $4.07 | $6.46 | $12.02 |