- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $27.54 / $54.95
| Facility | 26 | $26.92 | $27.54 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $56.23 / $223.87
| Professional | | $40.74 | $56.23 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $30.20 / $81.28
| Professional | 26 | $23.44 | $30.20 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Professional | 52 | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $23.99 / $102.33
| Professional | TC | $16.22 | $23.99 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $70.79 / $181.97
| Facility | 26 | $63.10 | $70.79 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $67.61 / $331.13
| Professional | | $45.71 | $67.61 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $181.97
| Professional | 26 | $25.12 | $37.15 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $31.62 / $151.36
| Professional | TC | $20.42 | $31.62 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $102.33 / $138.04
| Professional | | $60.26 | $102.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $54.95 / $74.13
| Professional | 26 | $32.36 | $54.95 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $30.20 / $51.29 / $69.18
| Professional | 52 | $30.20 | $51.29 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $61.66
| Professional | | $37.15 | $37.15 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $33.11
| Professional | 26 | $25.70 | $25.70 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $22.91
| Professional | TC | $11.75 | $11.75 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $38.90 / $67.61
| Professional | | $17.38 | $38.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $28.18 / $66.07
| Professional | | $17.38 | $28.18 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $29.51 / $58.88
| Professional | 26 | $17.38 | $29.51 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.92 / $10.47 / $33.88
| Professional | TC | $6.92 | $10.47 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $58.88 / $125.89
| Professional | | $31.62 | $58.88 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $70.79 / $181.97
| Facility | 26 | $63.10 | $70.79 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $67.61 / $331.13
| Professional | | $45.71 | $67.61 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $181.97
| Professional | 26 | $25.12 | $37.15 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $31.62 / $151.36
| Professional | TC | $20.42 | $31.62 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $50.12 / $97.72
| Professional | | $40.74 | $50.12 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $64.57 / $128.82
| Professional | | $32.36 | $64.57 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $37.15 / $85.11
| Professional | 26 | $23.44 | $37.15 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.47 / $27.54 / $61.66
| Professional | TC | $10.47 | $27.54 | $61.66 |