- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $64.57 / $229.09
| Facility | 26 | $27.54 | $64.57 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $64.57 / $125.89
| Professional | | $39.81 | $64.57 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $28.18 / $52.48
| Professional | 26 | $21.88 | $28.18 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $33.11 / $61.66
| Professional | TC | $15.14 | $33.11 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $74.13 / $169.82
| Professional | | $48.98 | $74.13 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $37.15 / $81.28
| Professional | 26 | $24.55 | $37.15 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $38.02 / $85.11
| Professional | TC | $20.89 | $38.02 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $91.20 / $123.03
| Professional | | $61.66 | $91.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $53.70
| Professional | 26 | $25.12 | $37.15 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $54.95 / $70.79
| Professional | TC | $37.15 | $54.95 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $56.23 / $117.49
| Professional | | $42.66 | $56.23 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $61.66
| Professional | 26 | $20.89 | $26.30 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $29.51 / $63.10
| Professional | TC | $23.44 | $29.51 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $60.26 / $123.03
| Professional | | $40.74 | $60.26 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $61.66
| Professional | 26 | $19.05 | $30.20 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $31.62 / $70.79
| Professional | TC | $18.62 | $31.62 | $70.79 |