- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $19.95
| Facility | 26 | $12.02 | $12.02 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $44.67 / $87.10
| Professional | | $33.11 | $44.67 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.02 / $25.70
| Professional | 26 | $7.94 | $12.02 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $33.11 / $64.57
| Professional | TC | $21.88 | $33.11 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $104.71 / $114.82
| Professional | | $77.62 | $104.71 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $26.92 / $30.20
| Professional | 26 | $20.42 | $26.92 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $75.86 / $85.11
| Professional | TC | $57.54 | $75.86 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $107.15
| Professional | | $44.67 | $67.61 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $17.38 / $28.18
| Professional | 26 | $11.75 | $17.38 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $79.43
| Professional | TC | $32.36 | $51.29 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $74.13 / $288.40
| Professional | | $41.69 | $74.13 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $21.38 / $107.15
| Professional | 26 | $12.02 | $21.38 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $52.48 / $269.15
| Professional | TC | $30.20 | $52.48 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $77.62 / $104.71
| Professional | | $43.65 | $77.62 | $104.71 |
- 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
- $29.51 / $51.29 / $87.10
| Professional | TC | $29.51 | $51.29 | $87.10 |