- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $32.36 / $123.03
| Facility | 26 | $23.99 | $32.36 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $128.82 / $346.74
| Professional | | $64.57 | $128.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $57.54 / $141.25
| Professional | 26 | $28.84 | $57.54 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $52.48 / $112.20
| Professional | TC | $32.36 | $52.48 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $75.86 / $123.03
| Professional | | $57.54 | $75.86 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $36.31 / $63.10
| Professional | 26 | $28.18 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $41.69 / $75.86
| Professional | TC | $37.15 | $41.69 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $52.48 / $66.07
| Professional | | $41.69 | $52.48 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $46.77 / $117.49
| Facility | 26 | $8.91 | $46.77 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $95.50 / $186.21
| Professional | | $58.88 | $95.50 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $41.69 / $81.28
| Professional | 26 | $25.70 | $41.69 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $109.65
| Professional | TC | $32.36 | $57.54 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | 26 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $83.18 / $125.89
| Professional | | $60.26 | $83.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $34.67 / $56.23
| Professional | 26 | $16.22 | $34.67 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $46.77 / $72.44
| Professional | TC | $21.38 | $46.77 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.02 / $75.86
| Professional | | $27.54 | $38.02 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $83.18 / $158.49
| Professional | | $67.61 | $83.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $36.31 / $85.11
| Professional | 26 | $28.84 | $36.31 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $93.33
| Professional | TC | $37.15 | $47.86 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $89.13
| Professional | | $60.26 | $60.26 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $38.02
| Professional | 26 | $25.12 | $25.12 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $52.48
| Professional | TC | $34.67 | $34.67 | $52.48 |