- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $22.39 / $26.30
| Facility | 26 | $14.13 | $22.39 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $48.98 / $117.49
| Professional | | $33.11 | $48.98 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.02 / $25.70
| Professional | 26 | $7.94 | $12.02 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $72.44
| Professional | TC | $22.91 | $32.36 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.51 / $11.75 / $16.98
| Facility | 26 | $2.51 | $11.75 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $75.86 / $114.82
| Professional | | $39.81 | $75.86 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $19.50 / $30.20
| Professional | 26 | $11.75 | $19.50 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $56.23 / $87.10
| Professional | TC | $28.84 | $56.23 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $91.20 / $112.20
| Professional | | $83.18 | $91.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $22.91 / $26.92
| Professional | 26 | $19.95 | $22.91 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $70.79 / $85.11
| Professional | TC | $61.66 | $70.79 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $22.39 / $26.30
| Facility | 26 | $14.13 | $22.39 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $125.89
| Professional | | $52.48 | $79.43 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $21.38 / $30.90
| Professional | 26 | $14.79 | $21.38 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $63.10 / $91.20
| Professional | TC | $42.66 | $63.10 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $24.55 / $50.12
| Professional | | $15.14 | $24.55 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $81.28 / $117.49
| Professional | | $61.66 | $81.28 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $21.88 / $30.20
| Professional | 26 | $14.13 | $21.88 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $56.23 / $89.13
| Professional | TC | $36.31 | $56.23 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 26 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $87.10 / $117.49
| Professional | | $69.18 | $87.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $22.91 / $30.20
| Professional | 26 | $19.05 | $22.91 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $64.57 / $89.13
| Professional | TC | $47.86 | $64.57 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $48.98 / $112.20
| Professional | | $36.31 | $48.98 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $13.18 / $30.20
| Professional | 26 | $10.23 | $13.18 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $36.31 / $81.28
| Professional | TC | $24.55 | $36.31 | $81.28 |