- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $15.85 / $25.70
| Facility | 26 | $15.14 | $15.85 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $58.88 / $125.89
| Professional | | $44.67 | $58.88 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $41.69
| Professional | 26 | $12.02 | $15.85 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $138.04
| Professional | TC | $33.88 | $48.98 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $144.54 / $158.49
| Professional | | $112.20 | $144.54 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $34.67 / $38.90
| Professional | 26 | $27.54 | $34.67 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $109.65 / $120.23
| Professional | TC | $85.11 | $109.65 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $95.50 / $151.36
| Professional | | $60.26 | $95.50 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $22.39 / $38.90
| Professional | 26 | $15.14 | $22.39 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $72.44 / $114.82
| Professional | TC | $41.69 | $72.44 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $104.71 / $398.11
| Professional | | $57.54 | $104.71 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $28.84 / $93.33
| Professional | 26 | $15.49 | $28.84 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $74.13 / $302.00
| Professional | TC | $41.69 | $74.13 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $107.15 / $144.54
| Professional | | $60.26 | $107.15 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $27.54 / $50.12
| Professional | 26 | $16.22 | $27.54 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $81.28 / $104.71
| Professional | TC | $42.66 | $81.28 | $104.71 |