- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $109.65 / $128.82
| Facility | 26 | $32.36 | $109.65 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $97.72 / $275.42
| Professional | | $51.29 | $97.72 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $37.15 / $97.72
| Professional | 26 | $20.89 | $37.15 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $35.48 / $63.10 / $151.36
| Professional | 52 | $35.48 | $63.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $50.12 / $120.23
| Professional | TC | $25.12 | $50.12 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $114.82 / $181.97
| Professional | | $57.54 | $114.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $38.90 / $56.23
| Professional | 26 | $26.92 | $38.90 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $72.44 / $128.82
| Professional | TC | $31.62 | $72.44 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $114.82 / $190.55
| Professional | | $69.18 | $114.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $69.18
| Professional | 26 | $28.18 | $38.90 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $67.61 / $120.23
| Professional | TC | $41.69 | $67.61 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $102.33 / $123.03
| Professional | | $87.10 | $102.33 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $45.71
| Professional | 26 | $25.12 | $37.15 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $57.54 / $75.86
| Professional | TC | $45.71 | $57.54 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $44.67 / $144.54
| Professional | | $24.55 | $44.67 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $89.13 / $173.78
| Professional | | $63.10 | $89.13 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $77.62
| Professional | 26 | $22.91 | $33.88 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $52.48 / $112.20
| Professional | TC | $35.48 | $52.48 | $112.20 |