- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $15.85 / $26.30
| Facility | 26 | $15.14 | $15.85 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $52.48 / $120.23
| Professional | | $37.15 | $52.48 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $19.95 / $38.02
| Professional | 26 | $12.02 | $19.95 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $67.61
| Professional | TC | $25.12 | $34.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $114.82 / $128.82
| Professional | | $87.10 | $114.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $35.48 / $39.81
| Professional | 26 | $26.92 | $35.48 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $89.13
| Professional | TC | $60.26 | $81.28 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $123.03
| Professional | | $50.12 | $75.86 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $22.91 / $39.81
| Professional | 26 | $15.49 | $22.91 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $53.70 / $83.18
| Professional | TC | $31.62 | $53.70 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $85.11 / $323.59
| Professional | | $46.77 | $85.11 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $29.51 / $128.82
| Professional | 26 | $15.49 | $29.51 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $54.95 / $251.19
| Professional | TC | $30.90 | $54.95 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $87.10 / $117.49
| Professional | | $48.98 | $87.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $27.54 / $50.12
| Professional | 26 | $15.85 | $27.54 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $51.29 / $91.20
| Professional | TC | $30.90 | $51.29 | $91.20 |