- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $60.26
| Facility | 26 | $28.18 | $28.18 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $269.15
| Professional | | $75.86 | $112.20 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $36.31 / $64.57
| Professional | 26 | $20.89 | $36.31 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $81.28 / $204.17
| Professional | TC | $54.95 | $81.28 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $158.49 / $218.78
| Professional | | $104.71 | $158.49 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $37.15 / $52.48
| Professional | 26 | $25.70 | $37.15 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $117.49 / $165.96
| Professional | TC | $79.43 | $117.49 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $165.96 / $295.12
| Professional | | $107.15 | $165.96 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $44.67 / $70.79
| Professional | 26 | $28.84 | $44.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $229.09
| Professional | TC | $79.43 | $125.89 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $190.55 / $288.40
| Professional | | $125.89 | $190.55 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $45.71 / $67.61
| Professional | 26 | $30.20 | $45.71 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $144.54 / $213.80
| Professional | TC | $93.33 | $144.54 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $154.88 / $380.19
| Professional | | $117.49 | $154.88 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $79.43
| Professional | 26 | $28.18 | $37.15 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $114.82 / $239.88
| Professional | TC | $87.10 | $114.82 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $23.44 / $25.70
| Facility | 26 | $18.20 | $23.44 | $25.70 |