- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $20.89 / $26.30
| Facility | 26 | $18.20 | $20.89 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $67.61 / $181.97
| Professional | | $45.71 | $67.61 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $15.85 / $39.81
| Professional | 26 | $10.00 | $15.85 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $50.12 / $109.65
| Professional | TC | $34.67 | $50.12 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $41.69
| Professional | | $39.81 | $39.81 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $41.69 / $74.13
| Professional | | $10.47 | $41.69 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $89.13 / $138.04
| Professional | | $53.70 | $89.13 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $22.39 / $31.62
| Professional | 26 | $12.59 | $22.39 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $66.07 / $102.33
| Professional | TC | $40.74 | $66.07 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $33.11 / $69.18
| Professional | | $26.30 | $33.11 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $104.71 / $138.04
| Professional | | $54.95 | $104.71 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $22.91 / $31.62
| Professional | 26 | $13.18 | $22.91 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $66.07 / $89.13
| Professional | TC | $41.69 | $66.07 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $69.18 / $138.04
| Professional | | $60.26 | $69.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $18.20 / $37.15
| Professional | 26 | $15.49 | $18.20 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $52.48 / $87.10
| Professional | TC | $44.67 | $52.48 | $87.10 |