- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $72.44 / $208.93
| Facility | 26 | $28.84 | $72.44 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $79.43 / $138.04
| Professional | | $66.07 | $79.43 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $95.50
| Professional | 26 | $28.18 | $45.71 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $47.86 / $77.62
| Professional | TC | $39.81 | $47.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $91.20 / $562.34
| Professional | | $31.62 | $91.20 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $35.48 / $35.48
| Professional | 26 | $30.90 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $56.23
| Professional | TC | $50.12 | $50.12 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $97.72 / $204.17
| Professional | | $67.61 | $97.72 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $85.11
| Professional | 26 | $28.18 | $39.81 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $125.89
| Professional | TC | $38.90 | $57.54 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $87.10 / $190.55
| Professional | | $77.62 | $87.10 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $33.11 / $72.44
| Professional | 26 | $29.51 | $33.11 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $52.48 / $120.23
| Professional | TC | $47.86 | $52.48 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $95.50 / $489.78
| Professional | | $72.44 | $95.50 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $91.20 / $194.98
| Professional | 26 | $29.51 | $91.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $70.79 / $186.21
| Professional | TC | $41.69 | $70.79 | $186.21 |