- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $25.70 / $66.07
| Facility | 26 | $16.98 | $25.70 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $41.69 / $128.82
| Professional | | $30.90 | $41.69 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $47.86
| Professional | 26 | $16.98 | $21.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $15.85 / $87.10
| Professional | TC | $14.13 | $15.85 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $37.15 / $45.71
| Professional | | $34.67 | $37.15 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $123.03 / $218.78
| Professional | | $47.86 | $123.03 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $41.69 / $69.18
| Professional | 26 | $25.70 | $41.69 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $186.21 / $323.59
| Professional | 50 | $70.79 | $186.21 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $77.62 / $151.36
| Professional | TC | $21.88 | $77.62 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $61.66 / $165.96
| Professional | | $34.67 | $61.66 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $31.62 / $60.26
| Professional | 26 | $19.50 | $31.62 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $26.92 / $117.49
| Professional | TC | $15.14 | $26.92 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.13 / $23.99 / $33.88
| Facility | 26 | $5.13 | $23.99 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $58.88 / $165.96
| Professional | | $32.36 | $58.88 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $30.90 / $54.95
| Professional | 26 | $18.62 | $30.90 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $24.55 / $117.49
| Professional | TC | $13.80 | $24.55 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $32.36 / $33.11
| Professional | | $21.38 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Facility | 26 | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $47.86 / $87.10
| Professional | | $38.90 | $47.86 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $26.30 / $47.86
| Professional | 26 | $21.38 | $26.30 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $21.88 / $38.90
| Professional | TC | $17.78 | $21.88 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $46.77 / $151.36
| Professional | | $31.62 | $46.77 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $48.98
| Professional | 26 | $18.20 | $26.30 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.18 / $19.50 / $107.15
| Professional | TC | $13.18 | $19.50 | $107.15 |