- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $29.51 / $46.77
| Facility | 26 | $21.88 | $29.51 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $42.66 / $107.15
| Professional | | $34.67 | $42.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $25.70 / $66.07
| Professional | 26 | $20.89 | $25.70 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $18.62 / $70.79
| Professional | TC | $12.02 | $18.62 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Professional | | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $26.92 / $28.84
| Professional | 26 | $16.22 | $26.92 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $79.43 / $147.91
| Professional | | $57.54 | $79.43 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $30.20 / $56.23
| Professional | 26 | $25.70 | $30.20 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $48.98 / $102.33
| Professional | TC | $34.67 | $48.98 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $26.30 / $51.29
| Professional | | $17.38 | $26.30 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $27.54 / $38.90
| Facility | 26 | $5.89 | $27.54 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $109.65 / $346.74
| Professional | | $45.71 | $109.65 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $44.67 / $128.82
| Professional | 26 | $25.70 | $44.67 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $74.13 / $165.96
| Professional | TC | $19.50 | $74.13 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $41.69
| Professional | | $32.36 | $33.11 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $72.44 / $93.33
| Professional | | $42.66 | $72.44 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $39.81
| Professional | 26 | $21.88 | $28.84 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $45.71 / $58.88
| Professional | TC | $19.95 | $45.71 | $58.88 |