- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $81.28
| Facility | 26 | $26.30 | $32.36 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $66.07 / $181.97
| Professional | | $45.71 | $66.07 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $50.12 / $97.72
| Professional | 26 | $25.70 | $50.12 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $24.55 / $56.23 / $169.82
| Professional | 52 | $24.55 | $56.23 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $31.62 / $107.15
| Professional | TC | $19.95 | $31.62 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $48.98 / $151.36
| Professional | | $38.90 | $48.98 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $50.12 / $72.44
| Professional | 26 | $28.84 | $50.12 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Professional | 52 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $18.62 / $32.36
| Professional | TC | $14.79 | $18.62 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $63.10 / $85.11
| Professional | 26 | $46.77 | $63.10 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $45.71 / $69.18
| Professional | TC | $38.02 | $45.71 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $79.43 / $141.25
| Professional | | $45.71 | $79.43 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $43.65 / $77.62
| Professional | 26 | $23.99 | $43.65 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $35.48 / $63.10
| Professional | TC | $20.89 | $35.48 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $48.98 / $104.71
| Professional | | $23.44 | $48.98 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $141.25
| Professional | | $51.29 | $77.62 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $41.69 / $83.18
| Professional | 26 | $28.18 | $41.69 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $63.10
| Professional | TC | $22.91 | $34.67 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | 26 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $436.52
| Professional | | $331.13 | $331.13 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $229.09
| Professional | 26 | $181.97 | $181.97 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $204.17
| Professional | TC | $151.36 | $151.36 | $204.17 |