- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $21.38 / $93.33
| Facility | 26 | $14.79 | $21.38 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $83.18 / $162.18
| Professional | | $63.10 | $83.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $17.78 / $41.69
| Professional | 26 | $14.13 | $17.78 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $57.54 / $112.20
| Professional | TC | $45.71 | $57.54 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $112.20
| Professional | | $54.95 | $56.23 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $15.85 / $18.20
| Professional | 26 | $14.13 | $15.85 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $74.13 / $154.88
| Professional | | $44.67 | $74.13 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $26.92 / $43.65
| Professional | 26 | $16.98 | $26.92 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $74.13 / $138.04
| Professional | TC | $46.77 | $74.13 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Facility | 26 | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $89.13 / $154.88
| Professional | | $61.66 | $89.13 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $23.44 / $39.81
| Professional | 26 | $15.14 | $23.44 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $66.07 / $120.23
| Professional | TC | $44.67 | $66.07 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Facility | 26 | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $676.08 / $676.08
| Professional | | $512.86 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $138.04 / $138.04
| Professional | 26 | $109.65 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $537.03 / $537.03
| Professional | TC | $398.11 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $81.28 / $147.91
| Professional | | $63.10 | $81.28 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $20.42 / $36.31
| Professional | 26 | $16.98 | $20.42 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $61.66 / $107.15
| Professional | TC | $46.77 | $61.66 | $107.15 |