- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $72.44 / $89.13
| Facility | 26 | $36.31 | $72.44 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $54.95 / $87.10
| Professional | | $41.69 | $54.95 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $28.18
| Professional | 26 | $12.02 | $15.85 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $60.26
| Professional | TC | $28.84 | $38.02 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $75.86 / $109.65
| Professional | | $45.71 | $75.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $21.38 / $33.88
| Professional | 26 | $13.49 | $21.38 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $52.48 / $79.43
| Professional | TC | $31.62 | $52.48 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $83.18 / $158.49
| Professional | | $48.98 | $83.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $23.44 / $45.71
| Professional | 26 | $14.45 | $23.44 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $58.88 / $114.82
| Professional | TC | $35.48 | $58.88 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $79.43 / $93.33
| Professional | | $56.23 | $79.43 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $22.39 / $27.54
| Professional | 26 | $18.20 | $22.39 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $53.70 / $69.18
| Professional | TC | $38.90 | $53.70 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $123.03
| Professional | | $50.12 | $75.86 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $22.91 / $36.31
| Professional | 26 | $15.14 | $22.91 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $52.48 / $87.10
| Professional | TC | $35.48 | $52.48 | $87.10 |