- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $28.18 / $83.18
| Facility | 26 | $22.91 | $28.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $102.33
| Professional | | $39.81 | $56.23 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $23.99 / $63.10
| Professional | 26 | $18.20 | $23.99 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $33.88 / $63.10
| Professional | TC | $18.62 | $33.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $54.95
| Professional | | $45.71 | $45.71 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $23.99
| Professional | 26 | $23.99 | $23.99 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $74.13 / $91.20
| Professional | | $41.69 | $74.13 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $29.51 / $38.90
| Professional | 26 | $21.38 | $29.51 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $44.67 / $57.54
| Professional | TC | $19.05 | $44.67 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $39.81
| Professional | 26 | $19.05 | $19.05 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $134.90
| Professional | | $40.74 | $63.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $28.18 / $56.23
| Professional | 26 | $17.78 | $28.18 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $38.90 / $74.13
| Professional | TC | $21.38 | $38.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $43.65 / $74.13
| Professional | | $33.88 | $43.65 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $20.89 / $34.67
| Professional | 26 | $16.60 | $20.89 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $23.99 / $40.74
| Professional | TC | $14.13 | $23.99 | $40.74 |