- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $36.31 / $75.86
| Facility | 26 | $16.60 | $36.31 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $83.18 / $275.42
| Professional | | $47.86 | $83.18 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $30.90 / $128.82
| Professional | 26 | $16.60 | $30.90 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $43.65 / $97.72
| Professional | TC | $30.20 | $43.65 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $173.78
| Professional | | $67.61 | $107.15 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $36.31 / $52.48
| Professional | 26 | $19.95 | $36.31 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $74.13 / $117.49
| Professional | TC | $42.66 | $74.13 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $158.49 / $316.23
| Professional | | $50.12 | $158.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $39.81 / $173.78
| Professional | 26 | $17.78 | $39.81 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $64.57 / $208.93
| Professional | TC | $31.62 | $64.57 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | 26 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $109.65 / $602.56
| Professional | | $56.23 | $109.65 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $457.09
| Professional | 26 | $19.05 | $32.36 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $74.13 / $389.05
| Professional | TC | $35.48 | $74.13 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $134.90 / $173.78
| Professional | | $102.33 | $134.90 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $43.65 / $52.48
| Professional | 26 | $36.31 | $43.65 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $128.82
| Professional | TC | $66.07 | $87.10 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $120.23 / $141.25
| Professional | | $87.10 | $120.23 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $44.67 / $47.86
| Professional | 26 | $34.67 | $44.67 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $95.50
| Professional | TC | $51.29 | $77.62 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $48.98 / $102.33
| Professional | | $18.20 | $48.98 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $87.10 / $144.54
| Professional | | $54.95 | $87.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $27.54 / $53.70
| Professional | 26 | $18.62 | $27.54 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $61.66 / $97.72
| Professional | TC | $34.67 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $117.49
| Professional | | $100.00 | $100.00 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $40.74
| Professional | 26 | $34.67 | $34.67 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $77.62
| Professional | TC | $66.07 | $66.07 | $77.62 |