- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $31.62 / $33.11
| Facility | 26 | $30.90 | $31.62 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $112.20 / $251.19
| Professional | | $81.28 | $112.20 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $89.13
| Professional | 26 | $22.91 | $33.11 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $81.28 / $151.36
| Professional | TC | $57.54 | $81.28 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $33.88 / $42.66
| Professional | 26 | $20.42 | $33.88 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $147.91 / $158.49
| Professional | | $109.65 | $147.91 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Professional | 26 | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Professional | TC | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $112.20 / $234.42
| Professional | | $77.62 | $112.20 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $33.11 / $67.61
| Professional | 26 | $20.89 | $33.11 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $83.18 / $190.55
| Professional | TC | $56.23 | $83.18 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $32.36 / $61.66
| Facility | 26 | $30.90 | $32.36 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $114.82 / $229.09
| Professional | | $83.18 | $114.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $32.36 / $74.13
| Professional | 26 | $22.39 | $32.36 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $162.18
| Professional | TC | $61.66 | $83.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $104.71 / $186.21
| Professional | | $77.62 | $104.71 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $30.20 / $52.48
| Professional | 26 | $21.88 | $30.20 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $72.44 / $154.88
| Professional | TC | $56.23 | $72.44 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $102.33 / $173.78
| Professional | | $83.18 | $102.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $30.90 / $162.18
| Professional | 26 | $24.55 | $30.90 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $74.13 / $128.82
| Professional | TC | $58.88 | $74.13 | $128.82 |