- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $50.12 / $53.70
| Facility | 26 | $26.92 | $50.12 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $177.83
| Professional | | $30.90 | $52.48 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $25.70 / $53.70
| Professional | 26 | $15.85 | $25.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $21.38 / $97.72
| Professional | TC | $12.88 | $21.38 | $97.72 |
- 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
- $51.29 / $83.18 / $144.54
| Professional | | $51.29 | $83.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $40.74 / $67.61
| Professional | 26 | $29.51 | $40.74 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $38.90 / $102.33
| Professional | TC | $22.91 | $38.90 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $87.10 / $104.71
| Professional | | $77.62 | $87.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $46.77 / $54.95
| Professional | 26 | $40.74 | $46.77 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $41.69 / $48.98
| Professional | TC | $36.31 | $41.69 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $47.86 / $53.70
| Facility | 26 | $26.92 | $47.86 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $89.13 / $213.80
| Professional | | $63.10 | $89.13 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $47.86 / $63.10
| Professional | 26 | $33.88 | $47.86 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $89.13
| Professional | TC | $30.20 | $40.74 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $61.66
| Professional | | $21.88 | $33.88 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $134.90
| Professional | | $67.61 | $85.11 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $46.77 / $67.61
| Professional | 26 | $32.36 | $46.77 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $38.90 / $141.25
| Professional | TC | $26.92 | $38.90 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Facility | 26 | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $117.49
| Professional | | $67.61 | $85.11 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $45.71 / $63.10
| Professional | 26 | $38.90 | $45.71 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $38.02 / $53.70
| Professional | TC | $29.51 | $38.02 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $75.86 / $147.91
| Professional | | $39.81 | $75.86 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $40.74 / $61.66
| Professional | 26 | $22.91 | $40.74 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $32.36 / $93.33
| Professional | TC | $16.98 | $32.36 | $93.33 |