- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $26.30 / $54.95
| Facility | 26 | $10.00 | $26.30 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $53.70 / $123.03
| Professional | | $38.90 | $53.70 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $12.02 / $28.84
| Professional | 26 | $8.91 | $12.02 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $38.90 / $74.13
| Professional | TC | $30.20 | $38.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Professional | | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $19.05 / $21.88
| Professional | 26 | $18.62 | $19.05 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $58.88 / $104.71
| Professional | | $43.65 | $58.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $15.85 / $26.92
| Professional | 26 | $11.48 | $15.85 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $43.65 / $77.62
| Professional | TC | $32.36 | $43.65 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $125.89
| Professional | | $42.66 | $67.61 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $16.98 / $29.51
| Professional | 26 | $10.23 | $16.98 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $97.72
| Professional | TC | $32.36 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $70.79 / $173.78
| Professional | | $53.70 | $70.79 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $15.49 / $40.74
| Professional | 26 | $11.48 | $15.49 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $56.23 / $128.82
| Professional | TC | $42.66 | $56.23 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $48.98 / $97.72
| Professional | | $11.75 | $48.98 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $57.54 / $104.71
| Professional | | $44.67 | $57.54 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $25.70
| Professional | 26 | $10.96 | $14.13 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $42.66 / $77.62
| Professional | TC | $33.11 | $42.66 | $77.62 |