- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $17.78 / $19.95
| Facility | 26 | $17.38 | $17.78 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $138.04
| Professional | | $51.29 | $74.13 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $18.20 / $39.81
| Professional | 26 | $12.88 | $18.20 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $50.12 / $95.50
| Professional | TC | $30.20 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $89.13 / $120.23
| Professional | | $54.95 | $89.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $20.42 / $30.90
| Professional | 26 | $12.02 | $20.42 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $63.10 / $91.20
| Professional | TC | $43.65 | $63.10 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $87.10 / $154.88
| Professional | | $61.66 | $87.10 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $23.99 / $40.74
| Professional | 26 | $17.38 | $23.99 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $66.07 / $120.23
| Professional | TC | $42.66 | $66.07 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $95.50 / $177.83
| Professional | | $75.86 | $95.50 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $21.88 / $40.74
| Professional | 26 | $17.38 | $21.88 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $74.13 / $138.04
| Professional | TC | $58.88 | $74.13 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $17.78 / $2,041.74
| Facility | 26 | $17.38 | $17.78 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $141.25
| Professional | | $54.95 | $79.43 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $19.05 / $37.15
| Professional | 26 | $13.80 | $19.05 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $58.88 / $107.15
| Professional | TC | $41.69 | $58.88 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $91.20 / $158.49
| Professional | | $61.66 | $91.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $25.12 / $95.50
| Professional | 26 | $15.49 | $25.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $60.26 / $107.15
| Professional | TC | $44.67 | $60.26 | $107.15 |