- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $39.81 / $66.07
| Facility | 26 | $26.92 | $39.81 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $57.54 / $251.19
| Professional | | $36.31 | $57.54 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $30.20 / $63.10
| Professional | 26 | $22.91 | $30.20 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | 52 | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $23.99 / $102.33
| Professional | TC | $15.14 | $23.99 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $30.90 / $43.65
| Facility | 26 | $6.61 | $30.90 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Professional | 26 | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $11.75
| Professional | TC | $11.75 | $11.75 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $93.33 / $114.82
| Professional | | $79.43 | $93.33 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $61.66 / $72.44
| Professional | 26 | $52.48 | $61.66 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $30.20 / $43.65
| Professional | TC | $25.12 | $30.20 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $39.81 / $77.62
| Facility | 26 | $38.02 | $39.81 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $138.04
| Professional | | $52.48 | $89.13 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $56.23 / $85.11
| Professional | 26 | $27.54 | $56.23 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | 52 | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $29.51 / $61.66
| Professional | TC | $20.89 | $29.51 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $39.81 / $63.10
| Professional | | $25.70 | $39.81 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $100.00 / $141.25
| Professional | | $37.15 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $69.18
| Professional | 26 | $25.70 | $25.70 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $45.71
| Professional | TC | $11.75 | $11.75 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | 26 | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $109.65 / $141.25
| Professional | | $89.13 | $109.65 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $61.66 / $81.28
| Professional | 26 | $48.98 | $61.66 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $64.57
| Professional | TC | $37.15 | $47.86 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $72.44 / $144.54
| Professional | | $56.23 | $72.44 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $41.69 / $83.18
| Professional | 26 | $30.90 | $41.69 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $67.61
| Professional | TC | $21.88 | $32.36 | $67.61 |