- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $32.36 / $128.82
| Facility | 26 | $18.20 | $32.36 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $70.79 / $223.87
| Professional | | $30.90 | $70.79 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $51.29 / $125.89
| Professional | 26 | $19.05 | $51.29 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $69.18 / $72.44 / $549.54
| Professional | 50 | $69.18 | $72.44 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.91 / $26.92 / $112.20
| Professional | TC | $8.91 | $26.92 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $81.28 / $151.36
| Facility | 26 | $36.31 | $81.28 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $72.44 / $363.08
| Professional | | $31.62 | $72.44 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $34.67 / $194.98
| Professional | 26 | $19.95 | $34.67 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.33 / $38.90 / $213.80
| Professional | TC | $9.33 | $38.90 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $117.49 / $186.21
| Professional | | $81.28 | $117.49 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $63.10 / $85.11
| Professional | 26 | $37.15 | $63.10 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $72.44 / $154.88
| Professional | | $35.48 | $72.44 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $38.02 / $72.44
| Professional | 26 | $22.39 | $38.02 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $30.20 / $87.10
| Professional | TC | $12.88 | $30.20 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $53.70 / $102.33
| Professional | | $33.11 | $53.70 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $77.62 / $162.18
| Professional | | $38.90 | $77.62 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $32.36 / $131.83
| Professional | 26 | $19.50 | $32.36 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.22 / $37.15 / $125.89
| Professional | TC | $11.22 | $37.15 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $60.26 / $134.90
| Professional | | $46.77 | $60.26 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $81.28 / $151.36
| Facility | 26 | $36.31 | $81.28 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $72.44 / $363.08
| Professional | | $31.62 | $72.44 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $34.67 / $194.98
| Professional | 26 | $19.95 | $34.67 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.33 / $38.90 / $213.80
| Professional | TC | $9.33 | $38.90 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $123.03
| Professional | | $25.12 | $36.31 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $79.43 / $194.98
| Professional | | $34.67 | $79.43 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $38.90 / $95.50
| Professional | 26 | $21.38 | $38.90 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.30 / $43.65 / $89.13
| Professional | TC | $12.30 | $43.65 | $89.13 |