- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $154.88
| Facility | 26 | $89.13 | $128.82 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $83.18 / $263.03
| Professional | | $64.57 | $83.18 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $144.54
| Professional | 26 | $33.88 | $50.12 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $75.86
| Professional | TC | $21.88 | $36.31 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $70.79 / $141.25
| Professional | | $57.54 | $70.79 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $35.48 / $70.79
| Professional | 26 | $28.84 | $35.48 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $35.48 / $70.79
| Professional | TC | $28.84 | $35.48 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $91.20 / $162.18
| Professional | | $60.26 | $91.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $52.48 / $95.50
| Professional | 26 | $36.31 | $52.48 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $37.15 / $81.28
| Professional | TC | $22.39 | $37.15 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $177.83
| Facility | 26 | $83.18 | $83.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $79.43 / $562.34
| Professional | | $58.88 | $79.43 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $51.29 / $234.42
| Professional | 26 | $35.48 | $51.29 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $30.90 / $245.47
| Professional | TC | $19.50 | $30.90 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $70.79 / $131.83
| Professional | | $57.54 | $70.79 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $43.65 / $77.62
| Professional | 26 | $33.88 | $43.65 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $28.84 / $56.23
| Professional | TC | $18.62 | $28.84 | $56.23 |