- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $38.90 / $158.49
| Facility | 26 | $20.89 | $38.90 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $102.33 / $162.18
| Professional | | $75.86 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $66.07
| Professional | 26 | $20.89 | $26.92 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $75.86 / $114.82
| Professional | TC | $53.70 | $75.86 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $91.20 / $125.89
| Professional | | $26.30 | $91.20 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $37.15
| Facility | 26 | $24.55 | $24.55 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $91.20 / $151.36
| Professional | | $77.62 | $91.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $26.30 / $41.69
| Professional | 26 | $21.38 | $26.30 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $66.07 / $109.65
| Professional | TC | $52.48 | $66.07 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $117.49 / $117.49
| Facility | 26 | $61.66 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $102.33 / $645.65
| Professional | | $81.28 | $102.33 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $28.18 / $165.96
| Professional | 26 | $23.99 | $28.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $478.63
| Professional | TC | $54.95 | $70.79 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $91.20 / $134.90
| Professional | | $75.86 | $91.20 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $26.92 / $45.71
| Professional | 26 | $23.44 | $26.92 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $95.50
| Professional | TC | $51.29 | $64.57 | $95.50 |