- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $30.20 / $38.90
| Facility | 26 | $26.92 | $30.20 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $54.95 / $141.25
| Professional | | $36.31 | $54.95 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $29.51 / $77.62
| Professional | 26 | $19.05 | $29.51 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $21.88 / $33.88
| Professional | TC | $15.85 | $21.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $66.07
| Professional | | $30.20 | $35.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $25.70 / $34.67
| Professional | 26 | $21.88 | $25.70 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $60.26 / $77.62
| Professional | | $56.23 | $60.26 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $35.48 / $43.65
| Professional | 26 | $30.90 | $35.48 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $25.70 / $35.48
| Professional | TC | $23.99 | $25.70 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $39.81 / $45.71
| Professional | 26 | $21.88 | $39.81 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $107.15
| Professional | | $30.90 | $48.98 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $26.92 / $51.29
| Professional | 26 | $16.60 | $26.92 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $22.39 / $50.12
| Professional | TC | $14.13 | $22.39 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $47.86 / $95.50
| Professional | | $35.48 | $47.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $25.12 / $38.90
| Professional | 26 | $18.62 | $25.12 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $21.88 / $53.70
| Professional | TC | $15.49 | $21.88 | $53.70 |