- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $22.39 / $60.26
| Facility | 26 | $12.02 | $22.39 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $87.10 / $263.03
| Professional | | $56.23 | $87.10 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $25.70 / $69.18
| Professional | 26 | $12.88 | $25.70 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $57.54 / $154.88
| Professional | TC | $37.15 | $57.54 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $37.15 / $95.50
| Facility | 26 | $16.98 | $37.15 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $89.13 / $457.09
| Professional | | $61.66 | $89.13 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $19.95 / $95.50
| Professional | 26 | $13.80 | $19.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $69.18 / $354.81
| Professional | TC | $46.77 | $69.18 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $29.51 / $38.90
| Professional | 26 | $17.38 | $29.51 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $120.23 / $162.18
| Professional | TC | $70.79 | $120.23 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $102.33 / $190.55
| Professional | | $54.95 | $102.33 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $22.39 / $43.65
| Professional | 26 | $12.02 | $22.39 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $81.28 / $151.36
| Professional | TC | $42.66 | $81.28 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $81.28 / $138.04
| Professional | | $19.50 | $81.28 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $112.20 / $213.80
| Professional | | $74.13 | $112.20 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $22.91 / $40.74
| Professional | 26 | $15.49 | $22.91 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $83.18 / $154.88
| Professional | TC | $58.88 | $83.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $87.10 / $123.03
| Professional | | $21.38 | $87.10 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $37.15 / $95.50
| Facility | 26 | $16.98 | $37.15 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $89.13 / $457.09
| Professional | | $61.66 | $89.13 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $19.95 / $95.50
| Professional | 26 | $13.80 | $19.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $69.18 / $354.81
| Professional | TC | $46.77 | $69.18 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $70.79 / $75.86
| Professional | | $64.57 | $70.79 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $95.50 / $223.87
| Professional | | $66.07 | $95.50 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $21.88 / $53.70
| Professional | 26 | $15.49 | $21.88 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $173.78
| Professional | TC | $51.29 | $74.13 | $173.78 |