- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $57.54
| Facility | 26 | $12.02 | $12.02 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $74.13 / $141.25
| Facility | TC | $20.89 | $74.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $45.71 / $162.18
| Professional | | $33.11 | $45.71 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $60.26
| Professional | 26 | $12.02 | $15.85 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $75.86
| Professional | TC | $20.89 | $28.84 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $36.31 / $93.33
| Facility | 26 | $16.22 | $36.31 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $83.18 / $204.17
| Facility | TC | $36.31 | $83.18 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $57.54 / $295.12
| Professional | | $39.81 | $57.54 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $19.95 / $93.33
| Professional | 26 | $13.18 | $19.95 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $38.90 / $204.17
| Professional | TC | $26.92 | $38.90 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $95.50 / $134.90
| Professional | | $58.88 | $95.50 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $28.84 / $38.90
| Professional | 26 | $16.98 | $28.84 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $66.07 / $123.03
| Professional | | $36.31 | $66.07 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $21.88 / $43.65
| Professional | 26 | $12.02 | $21.88 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $45.71 / $83.18
| Professional | TC | $23.99 | $45.71 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $43.65 / $81.28
| Professional | | $18.62 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $67.61 / $141.25
| Professional | | $46.77 | $67.61 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $20.89 / $38.90
| Professional | 26 | $15.14 | $20.89 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $43.65 / $83.18
| Professional | TC | $30.90 | $43.65 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $22.39 / $120.23
| Professional | | $21.38 | $22.39 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $36.31 / $93.33
| Facility | 26 | $16.22 | $36.31 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $83.18 / $204.17
| Facility | TC | $36.31 | $83.18 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $57.54 / $295.12
| Professional | | $39.81 | $57.54 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $19.95 / $93.33
| Professional | 26 | $13.18 | $19.95 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $38.90 / $204.17
| Professional | TC | $26.92 | $38.90 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $63.10 / $141.25
| Professional | | $44.67 | $63.10 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $21.38 / $45.71
| Professional | 26 | $15.49 | $21.38 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $91.20
| Professional | TC | $28.18 | $40.74 | $91.20 |