- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $54.95 / $169.82
| Facility | 26 | $31.62 | $54.95 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $190.55 / $416.87
| Professional | | $104.71 | $190.55 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $54.95 / $134.90
| Professional | 26 | $32.36 | $54.95 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $17.78 / $58.88 / $208.93
| Professional | 52 | $17.78 | $58.88 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $102.33 / $229.09
| Professional | TC | $77.62 | $102.33 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $104.71 / $218.78
| Professional | | $85.11 | $104.71 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $46.77 / $66.07
| Professional | 26 | $29.51 | $46.77 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $27.54 / $85.11 / $213.80
| Professional | 52 | $27.54 | $85.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $151.36
| Professional | TC | $64.57 | $85.11 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $154.88 / $251.19
| Professional | | $125.89 | $154.88 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $43.65 / $70.79
| Professional | 26 | $34.67 | $43.65 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $112.20 / $181.97
| Professional | TC | $91.20 | $112.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $97.72 / $158.49
| Professional | | $37.15 | $97.72 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $181.97 / $323.59
| Professional | | $112.20 | $181.97 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $52.48 / $93.33
| Professional | 26 | $32.36 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $134.90 / $239.88
| Professional | TC | $81.28 | $134.90 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $154.88 / $457.09
| Professional | | $128.82 | $154.88 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $45.71 / $128.82
| Professional | 26 | $35.48 | $45.71 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $158.49
| Professional | 52 | $114.82 | $114.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $114.82 / $331.13
| Professional | TC | $93.33 | $114.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $117.49 / $208.93
| Professional | | $37.15 | $117.49 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $173.78 / $288.40
| Professional | | $125.89 | $173.78 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $48.98 / $81.28
| Professional | 26 | $35.48 | $48.98 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $125.89 / $204.17
| Professional | TC | $89.13 | $125.89 | $204.17 |