- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $48.98 / $128.82
| Facility | 26 | $36.31 | $48.98 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $134.90 / $257.04
| Professional | | $66.07 | $134.90 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $40.74 / $79.43
| Professional | 26 | $33.11 | $40.74 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $93.33 / $186.21
| Professional | TC | $18.20 | $93.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $48.98
| Professional | 26 | $30.20 | $30.20 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $95.50 / $165.96
| Professional | | $69.18 | $95.50 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $54.95 / $79.43
| Professional | 26 | $41.69 | $54.95 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $35.48 / $117.49
| Professional | TC | $26.92 | $35.48 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $234.42
| Professional | | $190.55 | $190.55 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $69.18
| Professional | 26 | $57.54 | $57.54 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $165.96
| Professional | TC | $131.83 | $131.83 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $134.90 / $302.00
| Professional | | $79.43 | $134.90 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $97.72
| Professional | 26 | $38.02 | $54.95 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $93.33 / $199.53
| Professional | TC | $17.78 | $93.33 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $134.90 / $234.42
| Professional | | $77.62 | $134.90 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $53.70 / $91.20
| Professional | 26 | $37.15 | $53.70 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $93.33 / $162.18
| Professional | TC | $17.78 | $93.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Facility | 26 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $158.49 / $269.15
| Professional | | $91.20 | $158.49 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $48.98 / $87.10
| Professional | 26 | $39.81 | $48.98 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $109.65 / $177.83
| Professional | TC | $26.30 | $109.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $120.23 / $204.17
| Professional | | $61.66 | $120.23 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $45.71 / $74.13
| Professional | 26 | $30.20 | $45.71 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $75.86 / $134.90
| Professional | TC | $20.89 | $75.86 | $134.90 |