- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $58.88 / $69.18
| Facility | 26 | $15.85 | $58.88 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $58.88 / $151.36
| Professional | | $48.98 | $58.88 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.85 / $45.71
| Professional | 26 | $10.96 | $15.85 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $43.65 / $91.20
| Professional | TC | $36.31 | $43.65 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $79.43 / $112.20
| Professional | | $48.98 | $79.43 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $16.98 / $24.55
| Professional | 26 | $10.96 | $16.98 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $89.13
| Professional | TC | $38.90 | $61.66 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $151.36
| Professional | | $60.26 | $81.28 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $17.38 / $32.36
| Professional | 26 | $13.18 | $17.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $64.57 / $120.23
| Professional | TC | $46.77 | $64.57 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $93.33 / $131.83
| Professional | | $79.43 | $93.33 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $17.78 / $23.44
| Professional | 26 | $14.13 | $17.78 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $75.86 / $107.15
| Professional | TC | $63.10 | $75.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $21.88 / $151.36
| Professional | | $14.13 | $21.88 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $83.18 / $154.88
| Professional | | $51.29 | $83.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $18.20 / $37.15
| Professional | 26 | $11.22 | $18.20 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $64.57 / $123.03
| Professional | TC | $39.81 | $64.57 | $123.03 |