- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $52.48 / $74.13
| Facility | 26 | $17.38 | $52.48 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $190.55
| Professional | | $38.90 | $61.66 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.49 / $47.86
| Professional | 26 | $10.96 | $15.49 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $43.65 / $125.89
| Professional | TC | $30.90 | $43.65 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $114.82
| Professional | | $51.29 | $72.44 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $17.38 / $28.18
| Professional | 26 | $10.96 | $17.38 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $74.13 / $109.65 / $162.18
| Professional | 50 | $74.13 | $109.65 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $52.48 / $89.13
| Professional | TC | $38.90 | $52.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $83.18 / $138.04
| Professional | | $56.23 | $83.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $19.50 / $35.48
| Professional | 26 | $14.79 | $19.50 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $63.10 / $107.15
| Professional | TC | $39.81 | $63.10 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $66.07 / $97.72
| Professional | | $50.12 | $66.07 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $18.20 / $21.88
| Professional | 26 | $15.14 | $18.20 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $60.26 / $85.11
| Professional | TC | $41.69 | $60.26 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $27.54 / $128.82
| Professional | | $21.38 | $27.54 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $75.86 / $158.49
| Professional | | $47.86 | $75.86 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $16.98 / $40.74
| Professional | 26 | $11.75 | $16.98 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $61.66 / $125.89
| Professional | TC | $36.31 | $61.66 | $125.89 |