- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $42.66
| Facility | 26 | $21.88 | $30.90 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $61.66 / $123.03
| Professional | | $43.65 | $61.66 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $87.10
| Professional | 26 | $21.88 | $34.67 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $85.11
| Professional | TC | $21.88 | $32.36 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Professional | | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $20.89
| Professional | 26 | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $54.95 / $75.86
| Professional | | $28.18 | $54.95 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $42.66
| Facility | 26 | $26.92 | $26.92 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $85.11 / $128.82
| Professional | | $52.48 | $85.11 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $28.18 / $43.65
| Professional | 26 | $22.91 | $28.18 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $57.54 / $77.62
| Professional | TC | $25.70 | $57.54 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $123.03 / $123.03
| Facility | 26 | $64.57 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $79.43 / $562.34
| Professional | | $51.29 | $79.43 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $30.90 / $186.21
| Professional | 26 | $25.12 | $30.90 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $46.77 / $398.11
| Professional | TC | $25.70 | $46.77 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $63.10 / $112.20
| Professional | | $47.86 | $63.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $30.90 / $52.48
| Professional | 26 | $23.99 | $30.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $31.62 / $79.43
| Professional | TC | $23.99 | $31.62 | $79.43 |