- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $102.33 / $138.04
| Facility | 26 | $32.36 | $102.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $66.07 / $186.21
| Professional | | $45.71 | $66.07 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $43.65 / $104.71
| Professional | 26 | $25.12 | $43.65 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $15.85 / $47.86 / $194.98
| Professional | 52 | $15.85 | $47.86 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $104.71
| Professional | TC | $19.05 | $28.84 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $63.10
| Professional | | $32.36 | $40.74 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $22.91 / $27.54
| Professional | 26 | $18.20 | $22.91 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $10.00
| Professional | 52 | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $16.98 / $19.95
| Professional | TC | $15.14 | $16.98 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $79.43
| Professional | | $39.81 | $46.77 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $43.65
| Professional | 26 | $21.88 | $27.54 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $21.38 / $87.10
| Professional | TC | $18.20 | $21.38 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $32.36 / $46.77
| Facility | 26 | $6.92 | $32.36 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $112.20
| Professional | | $42.66 | $64.57 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $35.48 / $61.66
| Professional | 26 | $23.44 | $35.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $29.51 / $52.48
| Professional | TC | $19.50 | $29.51 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $128.82 / $128.82
| Facility | 26 | $67.61 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $66.07 / $331.13
| Professional | | $56.23 | $66.07 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $35.48 / $181.97
| Professional | 26 | $30.90 | $35.48 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $38.02 / $154.88 / $158.49
| Professional | 52 | $38.02 | $154.88 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $29.51 / $151.36
| Professional | TC | $25.70 | $29.51 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $66.07 / $120.23
| Professional | | $53.70 | $66.07 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $95.50
| Professional | 26 | $30.20 | $35.48 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $29.51 / $75.86
| Professional | TC | $25.12 | $29.51 | $75.86 |