- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $25.70 / $44.67
| Facility | 26 | $23.99 | $25.70 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $131.83 / $426.58
| Professional | | $91.20 | $131.83 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $91.20
| Professional | 26 | $21.88 | $33.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $95.50 / $177.83
| Professional | TC | $67.61 | $95.50 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $30.20
| Professional | 26 | $19.05 | $25.70 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $83.18 / $151.36
| Professional | | $77.62 | $83.18 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $28.84 / $51.29
| Professional | 26 | $26.92 | $28.84 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $51.29 / $107.15
| Professional | TC | $48.98 | $51.29 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $93.33 / $141.25
| Professional | | $25.70 | $93.33 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $28.84 / $40.74
| Facility | 26 | $6.17 | $28.84 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $154.88 / $575.44
| Professional | | $87.10 | $154.88 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $40.74 / $125.89
| Professional | 26 | $23.99 | $40.74 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $117.49 / $457.09
| Professional | TC | $57.54 | $117.49 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $95.50
| Professional | | $32.36 | $33.11 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $107.15 / $204.17
| Professional | | $74.13 | $107.15 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $27.54 / $48.98
| Professional | 26 | $22.91 | $27.54 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $83.18 / $162.18
| Professional | TC | $47.86 | $83.18 | $162.18 |