- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $33.88
| Facility | 26 | $28.18 | $28.18 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $380.19
| Professional | | $52.48 | $89.13 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $123.03
| Professional | 26 | $22.91 | $33.11 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $45.71 / $85.11 / $489.78
| Professional | 52 | $45.71 | $85.11 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $47.86 / $109.65
| Professional | TC | $25.12 | $47.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $77.62
| Professional | | $41.69 | $41.69 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $40.74 / $79.43
| Professional | 26 | $21.88 | $40.74 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $5.62 / $5.62 / $93.33
| Professional | 52 | $5.62 | $5.62 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $109.65
| Professional | | $54.95 | $70.79 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $26.30 / $44.67
| Professional | 26 | $25.70 | $26.30 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $37.15 / $69.18
| Professional | TC | $29.51 | $37.15 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $95.50 / $141.25
| Professional | | $66.07 | $95.50 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $52.48
| Professional | 26 | $21.88 | $33.88 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $57.54 / $93.33
| Professional | TC | $37.15 | $57.54 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.63 / $72.44 / $107.15
| Professional | | $0.63 | $72.44 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.27 / $28.84 / $45.71
| Professional | 26 | $0.27 | $28.84 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.36 / $39.81 / $66.07
| Professional | TC | $0.36 | $39.81 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.63 / $0.63 / $91.20
| Professional | | $0.63 | $0.63 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.27 / $0.27 / $41.69
| Professional | 26 | $0.27 | $0.27 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.36 / $0.36 / $50.12
| Professional | TC | $0.36 | $0.36 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $60.26 / $81.28
| Professional | | $56.23 | $60.26 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $27.54 / $38.90
| Professional | 26 | $26.30 | $27.54 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $33.11 / $46.77
| Professional | TC | $30.20 | $33.11 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $81.28 / $120.23
| Professional | | $52.48 | $81.28 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $29.51 / $44.67
| Professional | 26 | $19.50 | $29.51 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $51.29 / $85.11
| Professional | TC | $29.51 | $51.29 | $85.11 |