- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $37.15 / $38.02
| Facility | 26 | $32.36 | $37.15 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $218.78
| Professional | | $52.48 | $79.43 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $19.95 / $44.67
| Professional | 26 | $12.02 | $19.95 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $112.20
| Professional | TC | $38.02 | $57.54 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $112.20 / $154.88
| Professional | | $95.50 | $112.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $27.54 / $36.31
| Professional | 26 | $23.44 | $27.54 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $83.18 / $117.49
| Professional | TC | $70.79 | $83.18 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $151.36
| Professional | | $61.66 | $95.50 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $24.55 / $34.67
| Professional | 26 | $16.22 | $24.55 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $70.79 / $93.33
| Professional | TC | $44.67 | $70.79 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $234.42
| Professional | | $213.80 | $213.80 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $104.71
| Professional | 26 | $75.86 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $154.88
| Professional | TC | $109.65 | $109.65 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $37.15 / $38.02
| Facility | 26 | $32.36 | $37.15 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $117.49 / $173.78
| Professional | | $67.61 | $117.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $28.18 / $39.81
| Professional | 26 | $16.22 | $28.18 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $89.13 / $125.89
| Professional | TC | $51.29 | $89.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $32.36 / $39.81
| Professional | | $11.75 | $32.36 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $125.89 / $147.91
| Professional | | $102.33 | $125.89 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $29.51 / $35.48
| Professional | 26 | $23.44 | $29.51 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $95.50 / $112.20
| Professional | TC | $77.62 | $95.50 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $58.88 / $131.83
| Professional | | $57.54 | $58.88 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $32.36
| Professional | 26 | $13.80 | $13.80 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $51.29 / $97.72
| Professional | TC | $43.65 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $70.79 / $120.23
| Professional | | $60.26 | $70.79 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $17.38 / $30.90
| Professional | 26 | $15.49 | $17.38 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $50.12 / $89.13
| Professional | TC | $44.67 | $50.12 | $89.13 |