- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $60.26
| Facility | 26 | $48.98 | $48.98 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $114.82 / $512.86
| Professional | | $87.10 | $114.82 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $63.10 / $239.88
| Professional | 26 | $43.65 | $63.10 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $58.88 / $234.42
| Professional | TC | $42.66 | $58.88 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Professional | | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $147.91
| Professional | | $87.10 | $87.10 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $46.77 / $79.43
| Professional | 26 | $45.71 | $46.77 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $69.18
| Professional | TC | $40.74 | $40.74 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $158.49 / $239.88
| Professional | | $93.33 | $158.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $58.88 / $89.13
| Professional | 26 | $41.69 | $58.88 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $77.62 / $141.25
| Professional | TC | $43.65 | $77.62 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $112.20 / $158.49
| Professional | | $1.41 | $112.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.48 / $58.88 / $83.18
| Professional | 26 | $0.48 | $58.88 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.91 / $56.23 / $77.62
| Professional | TC | $0.91 | $56.23 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $1.41 / $141.25
| Professional | | $1.41 | $1.41 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.48 / $0.48 / $74.13
| Professional | 26 | $0.48 | $0.48 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.91 / $67.61 / $70.79
| Professional | TC | $0.91 | $67.61 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $93.33 / $93.33
| Professional | | $91.20 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $50.12 / $50.12
| Professional | 26 | $48.98 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $44.67 / $44.67
| Professional | TC | $41.69 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $120.23 / $204.17
| Professional | | $36.31 | $120.23 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $61.66 / $97.72
| Professional | 26 | $33.88 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $134.90
| Professional | TC | $44.67 | $67.61 | $134.90 |