- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $77.62 / $77.62
| Facility | 26 | $57.54 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $70.79 / $269.15
| Professional | | $56.23 | $70.79 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $91.20
| Professional | 26 | $25.70 | $38.02 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $34.67 / $79.43
| Professional | TC | $30.20 | $34.67 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $58.88
| Professional | 26 | $22.91 | $28.84 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $63.10 / $104.71
| Professional | | $47.86 | $63.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $26.92 / $44.67
| Professional | 26 | $20.42 | $26.92 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $36.31 / $60.26
| Professional | TC | $27.54 | $36.31 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $72.44 / $134.90
| Professional | | $56.23 | $72.44 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $33.11 / $60.26
| Professional | 26 | $26.30 | $33.11 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $38.02 / $72.44
| Professional | TC | $29.51 | $38.02 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $123.03 / $123.03
| Facility | 26 | $64.57 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $75.86 / $724.44
| Professional | | $53.70 | $75.86 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $331.13
| Professional | 26 | $25.12 | $34.67 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $38.90 / $562.34
| Professional | TC | $27.54 | $38.90 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $63.10 / $112.20
| Professional | | $51.29 | $63.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $30.20 / $56.23
| Professional | 26 | $24.55 | $30.20 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $33.88 / $60.26
| Professional | TC | $26.92 | $33.88 | $60.26 |