- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $36.31 / $45.71
| Facility | 26 | $31.62 | $36.31 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $79.43 / $194.98
| Professional | | $46.77 | $79.43 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $87.10
| Professional | 26 | $21.88 | $33.88 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $38.02 / $81.28 / $354.81
| Professional | 52 | $38.02 | $81.28 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $42.66 / $85.11
| Professional | TC | $25.12 | $42.66 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $46.77 / $58.88
| Professional | | $43.65 | $46.77 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.50 / $21.88 / $44.67
| Professional | 26 | $5.50 | $21.88 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $97.72 / $125.89
| Professional | | $85.11 | $97.72 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $31.62 / $40.74
| Professional | 26 | $27.54 | $31.62 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $66.07 / $85.11
| Professional | TC | $57.54 | $66.07 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $41.69 / $72.44
| Professional | | $26.92 | $41.69 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $30.90 / $44.67
| Facility | 26 | $6.61 | $30.90 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $93.33 / $141.25
| Professional | | $50.12 | $93.33 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $33.88 / $56.23
| Professional | 26 | $20.89 | $33.88 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $56.23 / $87.10
| Professional | TC | $24.55 | $56.23 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Professional | | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $48.98 / $60.26
| Professional | 26 | $12.88 | $48.98 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $107.15
| Professional | TC | $61.66 | $61.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $144.54
| Professional | | $67.61 | $85.11 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $56.23
| Professional | 26 | $25.70 | $32.36 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $52.48 / $91.20
| Professional | TC | $42.66 | $52.48 | $91.20 |