- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $165.96
| Facility | 26 | $26.30 | $26.30 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $52.48 / $89.13
| Professional | | $40.74 | $52.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $19.05 / $39.81
| Professional | 26 | $14.13 | $19.05 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $33.11 / $53.70
| Professional | TC | $19.05 | $33.11 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Professional | | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $33.88 / $57.54
| Professional | | $12.59 | $33.88 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $54.95 / $75.86
| Professional | | $35.48 | $54.95 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $28.18 / $39.81
| Professional | 26 | $17.78 | $28.18 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $24.55 / $43.65
| Professional | TC | $16.22 | $24.55 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $33.11 / $63.10
| Professional | | $30.20 | $33.11 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $56.23 / $95.50
| Professional | | $37.15 | $56.23 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $28.18 / $39.81
| Professional | 26 | $19.05 | $28.18 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $25.12 / $43.65
| Professional | TC | $16.98 | $25.12 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $60.26 / $81.28
| Professional | | $44.67 | $60.26 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $31.62 / $42.66
| Professional | 26 | $20.42 | $31.62 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $26.92 / $42.66
| Professional | TC | $21.38 | $26.92 | $42.66 |