- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $30.90 / $52.48
| Facility | 26 | $24.55 | $30.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $56.23 / $112.20
| Professional | | $37.15 | $56.23 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $28.18 / $56.23
| Professional | 26 | $18.20 | $28.18 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $52.48
| Professional | TC | $18.20 | $26.92 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $47.86 / $72.44
| Professional | | $36.31 | $47.86 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $18.20 / $25.70
| Professional | 26 | $12.88 | $18.20 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $22.91 / $32.36
| Professional | TC | $19.50 | $22.91 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $64.57 / $141.25
| Professional | | $38.02 | $64.57 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $24.55 / $45.71
| Professional | 26 | $17.78 | $24.55 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $33.88 / $107.15
| Professional | TC | $19.50 | $33.88 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $114.82 / $114.82
| Facility | 26 | $56.23 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $95.50 / $575.44
| Professional | | $47.86 | $95.50 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $30.90 / $234.42
| Professional | 26 | $19.50 | $30.90 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $75.86 / $398.11
| Professional | TC | $23.44 | $75.86 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $67.61 / $112.20
| Professional | | $47.86 | $67.61 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $26.30 / $45.71
| Professional | 26 | $19.05 | $26.30 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $85.11
| Professional | TC | $23.44 | $32.36 | $85.11 |