- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $181.97 / $288.40
| Facility | 26 | $51.29 | $181.97 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $95.50 / $416.87
| Professional | | $70.79 | $95.50 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $42.66 / $81.28
| Professional | 26 | $33.11 | $42.66 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $48.98 / $128.82
| Professional | TC | $32.36 | $48.98 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Professional | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $53.70 / $69.18
| Professional | 26 | $28.84 | $53.70 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $83.18
| Professional | 26 | $44.67 | $44.67 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Facility | 26 | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $114.82 / $213.80
| Professional | | $63.10 | $114.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $79.43
| Professional | 26 | $28.84 | $47.86 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $58.88 / $141.25
| Professional | TC | $27.54 | $58.88 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $109.65 / $131.83
| Professional | | $81.28 | $109.65 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $60.26
| Professional | 26 | $37.15 | $50.12 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $60.26 / $72.44
| Professional | TC | $43.65 | $60.26 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $72.44 / $134.90
| Professional | | $61.66 | $72.44 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $38.02 / $60.26
| Professional | 26 | $32.36 | $38.02 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $33.88 / $72.44
| Professional | TC | $28.84 | $33.88 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $97.72 / $177.83
| Professional | | $61.66 | $97.72 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $44.67 / $79.43
| Professional | 26 | $29.51 | $44.67 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $48.98 / $117.49
| Professional | TC | $28.84 | $48.98 | $117.49 |