- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $41.69 / $81.28
| Facility | 26 | $33.88 | $41.69 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $114.82 / $398.11
| Professional | | $67.61 | $114.82 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $54.95 / $138.04
| Professional | 26 | $28.84 | $54.95 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $79.43 / $229.09 / $776.25
| Professional | 50 | $79.43 | $229.09 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $154.88
| Professional | TC | $52.48 | $70.79 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $75.86 / $173.78
| Professional | | $72.44 | $75.86 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $40.74 / $77.62
| Professional | 26 | $25.70 | $40.74 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $109.65 / $112.20 / $251.19
| Professional | 50 | $109.65 | $112.20 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $117.49 / $194.98
| Professional | | $97.72 | $117.49 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $41.69 / $67.61
| Professional | 26 | $36.31 | $41.69 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $147.91 / $173.78 / $288.40
| Professional | 50 | $147.91 | $173.78 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $75.86 / $125.89
| Professional | TC | $61.66 | $75.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $109.65 / $147.91
| Professional | | $102.33 | $109.65 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $39.81 / $57.54
| Professional | 26 | $36.31 | $39.81 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $72.44 / $95.50
| Professional | TC | $66.07 | $72.44 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $39.81 / $56.23
| Facility | 26 | $8.51 | $39.81 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $245.47
| Professional | | $85.11 | $125.89 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $45.71 / $91.20
| Professional | 26 | $30.20 | $45.71 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $169.82
| Professional | TC | $57.54 | $85.11 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $158.49 / $158.49
| Facility | 26 | $81.28 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $123.03 / $660.69
| Professional | | $93.33 | $123.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $43.65 / $218.78
| Professional | 26 | $32.36 | $43.65 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $81.28 / $446.68
| Professional | TC | $61.66 | $81.28 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $117.49 / $194.98
| Professional | | $93.33 | $117.49 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $41.69 / $89.13
| Professional | 26 | $33.11 | $41.69 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | 50 | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $75.86 / $123.03
| Professional | TC | $61.66 | $75.86 | $123.03 |