- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $50.12 / $147.91
| Facility | 26 | $41.69 | $50.12 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $75.86 / $131.83
| Professional | | $61.66 | $75.86 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $42.66 / $67.61
| Professional | 26 | $33.11 | $42.66 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $33.88 / $63.10
| Professional | TC | $20.89 | $33.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $95.50
| Professional | | $70.79 | $70.79 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $43.65
| Professional | 26 | $39.81 | $39.81 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $95.50 / $120.23
| Professional | | $57.54 | $95.50 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $52.48 / $67.61
| Professional | 26 | $37.15 | $52.48 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $44.67 / $57.54
| Professional | TC | $20.42 | $44.67 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $51.29 / $51.29
| Professional | 26 | $39.81 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $91.20 / $177.83
| Professional | | $58.88 | $91.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $109.65
| Professional | 26 | $33.88 | $50.12 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $38.90 / $75.86
| Professional | TC | $23.99 | $38.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $102.33
| Professional | | $52.48 | $63.10 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $39.81 / $61.66
| Professional | 26 | $30.90 | $39.81 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $41.69
| Professional | TC | $17.38 | $24.55 | $41.69 |