- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $60.26 / $70.79
| Facility | 26 | $16.98 | $60.26 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $40.74 / $77.62
| Professional | | $34.67 | $40.74 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.02 / $21.88
| Professional | 26 | $10.00 | $12.02 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $28.84 / $50.12
| Professional | TC | $23.99 | $28.84 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $61.66 / $87.10
| Professional | | $37.15 | $61.66 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $17.38 / $25.12
| Professional | 26 | $11.22 | $17.38 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $43.65 / $61.66
| Professional | TC | $25.70 | $43.65 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $64.57 / $117.49
| Professional | | $45.71 | $64.57 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $17.38 / $33.11
| Professional | 26 | $13.49 | $17.38 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $46.77 / $81.28
| Professional | TC | $32.36 | $46.77 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $72.44 / $97.72
| Professional | | $58.88 | $72.44 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $18.62 / $23.99
| Professional | 26 | $14.45 | $18.62 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $52.48 / $74.13
| Professional | TC | $44.67 | $52.48 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $64.57 / $117.49
| Professional | | $38.90 | $64.57 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $18.20 / $33.11
| Professional | 26 | $11.75 | $18.20 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $46.77 / $85.11
| Professional | TC | $26.92 | $46.77 | $85.11 |