- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $23.99 / $36.31
| Facility | 26 | $15.14 | $23.99 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $112.20 / $446.68
| Professional | | $72.44 | $112.20 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $15.14 / $46.77
| Professional | 26 | $10.72 | $15.14 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $19.05 / $229.09 / $229.09
| Professional | 52 | $19.05 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $93.33 / $169.82
| Professional | TC | $64.57 | $93.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Professional | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $20.89 / $25.70
| Professional | 26 | $9.33 | $20.89 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $120.23 / $165.96
| Professional | | $72.44 | $120.23 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $17.38 / $23.99
| Professional | 26 | $10.47 | $17.38 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $102.33 / $141.25
| Professional | TC | $63.10 | $102.33 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $177.83 / $223.87
| Professional | | $74.13 | $177.83 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $24.55 / $33.11
| Professional | 26 | $11.22 | $24.55 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $154.88 / $190.55
| Professional | TC | $63.10 | $154.88 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Facility | 26 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $162.18 / $776.25
| Professional | | $87.10 | $162.18 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $22.39 / $269.15
| Professional | 26 | $12.88 | $22.39 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $147.91 / $691.83
| Professional | TC | $91.20 | $147.91 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $177.83 / $213.80
| Professional | | $158.49 | $177.83 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $25.70 / $31.62
| Professional | 26 | $22.91 | $25.70 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $151.36 / $181.97
| Professional | TC | $134.90 | $151.36 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $181.97 / $194.98
| Professional | | $120.23 | $181.97 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $22.91 / $28.18
| Professional | 26 | $15.14 | $22.91 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $154.88 / $177.83
| Professional | TC | $107.15 | $154.88 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $79.43 / $169.82
| Professional | | $13.18 | $79.43 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $154.88 / $218.78
| Professional | | $87.10 | $154.88 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $21.38 / $29.51
| Professional | 26 | $13.49 | $21.38 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $131.83 / $194.98
| Professional | TC | $75.86 | $131.83 | $194.98 |