- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $54.95 / $158.49
| Facility | 26 | $30.90 | $54.95 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $181.97 / $676.08
| Professional | | $95.50 | $181.97 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $43.65 / $138.04
| Professional | 26 | $36.31 | $43.65 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $123.03 / $316.23
| Professional | TC | $63.10 | $123.03 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $251.19 / $251.19
| Facility | 26 | $93.33 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $213.80 / $1,318.26
| Professional | | $97.72 | $213.80 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $56.23 / $331.13
| Professional | 26 | $36.31 | $56.23 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $151.36 / $1,096.48
| Professional | TC | $70.79 | $151.36 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $288.40 / $489.78
| Professional | | $165.96 | $288.40 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $79.43 / $104.71
| Professional | 26 | $45.71 | $79.43 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $208.93 / $354.81
| Professional | | $93.33 | $208.93 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $58.88 / $120.23
| Professional | 26 | $33.88 | $58.88 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $147.91 / $263.03
| Professional | TC | $58.88 | $147.91 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $102.33 / $204.17
| Professional | | $50.12 | $102.33 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $181.97 / $323.59
| Professional | | $125.89 | $181.97 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $57.54 / $107.15
| Professional | 26 | $40.74 | $57.54 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $114.82 / $194.98
| Professional | TC | $81.28 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $234.42
| Professional | | $56.23 | $74.13 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $251.19 / $251.19
| Facility | 26 | $93.33 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $213.80 / $1,318.26
| Professional | | $97.72 | $213.80 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $56.23 / $331.13
| Professional | 26 | $36.31 | $56.23 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $151.36 / $1,096.48
| Professional | TC | $70.79 | $151.36 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $128.82 / $199.53
| Professional | | $64.57 | $128.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $204.17 / $426.58
| Professional | | $114.82 | $204.17 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $138.04
| Professional | 26 | $40.74 | $58.88 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $281.84
| Professional | TC | $74.13 | $120.23 | $281.84 |