- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $53.70 / $69.18
| Facility | 26 | $38.02 | $53.70 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $102.33 / $478.63
| Professional | | $47.86 | $102.33 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $40.74 / $102.33
| Professional | 26 | $22.91 | $40.74 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $50.12 / $107.15
| Professional | TC | $22.91 | $50.12 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $120.23 / $213.80
| Professional | | $66.07 | $120.23 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $50.12 / $77.62
| Professional | 26 | $28.18 | $50.12 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $67.61 / $154.88
| Professional | TC | $34.67 | $67.61 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $131.83 / $158.49
| Professional | | $117.49 | $131.83 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $57.54 / $67.61
| Professional | 26 | $51.29 | $57.54 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $72.44 / $91.20
| Professional | TC | $64.57 | $72.44 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $53.70 / $69.18
| Facility | 26 | $38.02 | $53.70 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $125.89 / $194.98
| Professional | | $72.44 | $125.89 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $54.95 / $81.28
| Professional | 26 | $30.20 | $54.95 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $69.18 / $104.71
| Professional | TC | $38.02 | $69.18 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $109.65
| Professional | | $38.90 | $57.54 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $125.89 / $204.17
| Professional | | $91.20 | $125.89 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $56.23 / $77.62
| Professional | 26 | $36.31 | $56.23 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $74.13 / $158.49
| Professional | TC | $48.98 | $74.13 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | 26 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $138.04 / $177.83
| Professional | | $107.15 | $138.04 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $60.26 / $79.43
| Professional | 26 | $50.12 | $60.26 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $70.79 / $97.72
| Professional | TC | $56.23 | $70.79 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $173.78
| Professional | | $57.54 | $89.13 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $79.43
| Professional | 26 | $26.92 | $32.36 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $50.12 / $93.33
| Professional | TC | $30.20 | $50.12 | $93.33 |