- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $57.54
| Facility | 26 | $33.11 | $33.11 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $70.79 / $131.83
| Professional | | $51.29 | $70.79 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $32.36 / $75.86
| Professional | 26 | $28.84 | $32.36 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $38.02 / $72.44
| Professional | TC | $19.50 | $38.02 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $26.92 / $28.18
| Facility | 26 | $23.44 | $26.92 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $162.18 / $239.88
| Professional | | $97.72 | $162.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $75.86 / $109.65
| Professional | 26 | $44.67 | $75.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $91.20 / $131.83
| Professional | TC | $53.70 | $91.20 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $114.82 / $275.42
| Facility | 26 | $81.28 | $114.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $186.21 / $288.40
| Professional | | $114.82 | $186.21 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $87.10 / $131.83
| Professional | 26 | $52.48 | $87.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $102.33 / $154.88
| Professional | TC | $61.66 | $102.33 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $109.65 / $218.78
| Facility | 26 | $89.13 | $109.65 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $169.82 / $263.03
| Professional | | $112.20 | $169.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $77.62 / $120.23
| Professional | 26 | $52.48 | $77.62 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $91.20 / $141.25
| Professional | TC | $61.66 | $91.20 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Facility | 26 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $123.03 / $309.03
| Professional | | $64.57 | $123.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $66.07 / $165.96
| Professional | 26 | $36.31 | $66.07 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $53.70 / $144.54
| Professional | TC | $25.70 | $53.70 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $128.82 / $234.42
| Professional | | $67.61 | $128.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $64.57 / $117.49
| Professional | 26 | $37.15 | $64.57 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $67.61 / $120.23
| Professional | TC | $27.54 | $67.61 | $120.23 |