- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $31.62
| Facility | 26 | $17.78 | $17.78 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $57.54 / $154.88
| Professional | | $45.71 | $57.54 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $38.02 / $102.33
| Professional | 26 | $16.98 | $38.02 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $33.88 / $91.20
| Professional | TC | $25.70 | $33.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $70.79 / $194.98
| Professional | | $29.51 | $70.79 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $31.62 / $69.18
| Professional | 26 | $12.02 | $31.62 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $36.31 / $120.23
| Professional | TC | $17.78 | $36.31 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $47.86 / $93.33
| Professional | | $27.54 | $47.86 | $93.33 |
- 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
- $37.15 / $83.18 / $245.47
| Professional | | $37.15 | $83.18 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $33.88 / $91.20
| Professional | 26 | $15.14 | $33.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $51.29 / $154.88
| Professional | TC | $21.88 | $51.29 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $83.18 / $128.82
| Professional | | $54.95 | $83.18 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $28.18 / $56.23
| Professional | 26 | $19.95 | $28.18 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $60.26 / $91.20
| Professional | TC | $43.65 | $60.26 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $81.28 / $147.91
| Professional | | $54.95 | $81.28 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $29.51 / $53.70
| Professional | 26 | $21.88 | $29.51 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $52.48 / $95.50
| Professional | TC | $33.11 | $52.48 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $56.23
| Professional | 26 | $18.20 | $18.20 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $77.62
| Professional | | $75.86 | $75.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $31.62
| Professional | 26 | $26.92 | $26.92 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $48.98 / $58.88
| Professional | TC | $46.77 | $48.98 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $74.13 / $151.36
| Professional | | $36.31 | $74.13 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $26.92 / $63.10
| Professional | 26 | $14.45 | $26.92 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $47.86 / $87.10
| Professional | TC | $22.91 | $47.86 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $158.49
| Professional | | $54.95 | $75.86 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $57.54
| Professional | 26 | $21.88 | $27.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $48.98 / $102.33
| Professional | TC | $33.11 | $48.98 | $102.33 |