- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $36.31
| Facility | 26 | $22.91 | $22.91 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $42.66 / $131.83
| Professional | | $32.36 | $42.66 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $22.91 / $61.66
| Professional | 26 | $16.98 | $22.91 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $16.98 / $89.13
| Professional | TC | $14.13 | $16.98 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $53.70 / $89.13
| Professional | | $37.15 | $53.70 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $42.66
| Professional | 26 | $19.05 | $28.84 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $39.81 / $60.26 / $89.13
| Professional | 50 | $39.81 | $60.26 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $24.55 / $40.74
| Professional | TC | $16.60 | $24.55 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Facility | 26 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $69.18 / $165.96
| Professional | | $38.90 | $69.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $58.88
| Professional | 26 | $21.88 | $35.48 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $30.20 / $114.82
| Professional | TC | $16.22 | $30.20 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $64.57 / $281.84
| Professional | | $58.88 | $64.57 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $74.13
| Professional | 26 | $30.90 | $33.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $30.20 / $208.93
| Professional | TC | $27.54 | $30.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $40.74 / $60.26
| Professional | | $37.15 | $40.74 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $21.38 / $33.11
| Professional | 26 | $20.89 | $21.38 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $19.50 / $26.92
| Professional | TC | $16.60 | $19.50 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $67.61 / $151.36
| Professional | | $39.81 | $67.61 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $56.23
| Professional | 26 | $22.91 | $38.02 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $26.92 / $107.15
| Professional | TC | $16.98 | $26.92 | $107.15 |