- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Facility | 26 | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $56.23 / $151.36
| Professional | | $37.15 | $56.23 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $28.18 / $69.18
| Professional | 26 | $19.05 | $28.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $33.88 / $89.13
| Professional | TC | $15.85 | $33.88 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $138.04 / $199.53
| Professional | | $54.95 | $138.04 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $50.12 / $72.44
| Professional | 26 | $19.95 | $50.12 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $87.10 / $128.82
| Professional | TC | $35.48 | $87.10 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $165.96
| Professional | | $57.54 | $85.11 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $36.31 / $57.54
| Professional | 26 | $26.30 | $36.31 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $51.29 / $107.15
| Professional | TC | $26.30 | $51.29 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $77.62 / $147.91
| Professional | | $48.98 | $77.62 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $52.48
| Professional | 26 | $21.88 | $28.84 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $51.29 / $97.72
| Professional | TC | $38.90 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $87.10 / $169.82
| Professional | | $54.95 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $61.66
| Professional | 26 | $21.88 | $36.31 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $46.77 / $97.72
| Professional | TC | $25.70 | $46.77 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $15.85 / $23.99
| Facility | 26 | $15.14 | $15.85 | $23.99 |