- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $25.12
| Facility | 26 | $14.13 | $14.13 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $54.95 / $134.90
| Professional | | $41.69 | $54.95 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $14.13 / $39.81
| Professional | 26 | $11.75 | $14.13 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $38.90 / $77.62
| Professional | TC | $28.84 | $38.90 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.02 / $12.02
| Facility | 26 | $10.00 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $134.90 / $194.98
| Professional | | $89.13 | $134.90 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $50.12
| Professional | 26 | $22.91 | $34.67 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $144.54
| Professional | TC | $67.61 | $107.15 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $50.12 / $123.03
| Facility | 26 | $22.91 | $50.12 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $104.71 / $165.96
| Professional | | $63.10 | $104.71 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $26.30 / $42.66
| Professional | 26 | $16.98 | $26.30 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $79.43 / $123.03
| Professional | TC | $45.71 | $79.43 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $48.98 / $97.72
| Facility | 26 | $39.81 | $48.98 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $138.04
| Professional | | $83.18 | $83.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $34.67
| Professional | 26 | $20.89 | $20.89 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $102.33
| Professional | TC | $61.66 | $61.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $89.13 / $323.59
| Professional | | $50.12 | $89.13 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $26.92 / $91.20
| Professional | 26 | $13.80 | $26.92 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $64.57 / $234.42
| Professional | TC | $35.48 | $64.57 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $85.11 / $407.38
| Professional | | $58.88 | $85.11 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $85.11 / $114.82
| Professional | 26 | $18.20 | $85.11 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $67.61 / $128.82
| Professional | TC | $37.15 | $67.61 | $128.82 |