- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $46.77 / $60.26
| Facility | 26 | $41.69 | $46.77 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $107.15 / $239.88
| Professional | | $69.18 | $107.15 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $48.98 / $120.23
| Professional | 26 | $30.20 | $48.98 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $51.29 / $95.50
| Professional | TC | $38.02 | $51.29 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $79.43 / $125.89
| Professional | | $58.88 | $79.43 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $38.90 / $52.48
| Professional | 26 | $33.88 | $38.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $70.79
| Professional | TC | $33.88 | $48.98 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $114.82 / $151.36
| Professional | | $104.71 | $114.82 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $54.95 / $67.61
| Professional | 26 | $46.77 | $54.95 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $61.66 / $81.28
| Professional | TC | $56.23 | $61.66 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $39.81 / $63.10
| Professional | 26 | $33.88 | $39.81 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $177.83
| Professional | | $57.54 | $91.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $41.69 / $75.86
| Professional | 26 | $25.70 | $41.69 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $51.29 / $102.33
| Professional | TC | $30.90 | $51.29 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $89.13 / $141.25
| Professional | | $67.61 | $89.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $60.26
| Professional | 26 | $28.18 | $38.90 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $79.43
| Professional | TC | $37.15 | $48.98 | $79.43 |