- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $229.09 / $316.23
| Facility | 26 | $87.10 | $229.09 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $302.00 / $1,148.15
| Professional | | $186.21 | $302.00 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $102.33 / $257.04
| Professional | 26 | $60.26 | $102.33 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $194.98 / $562.34
| Professional | TC | $120.23 | $194.98 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $138.04 / $154.88
| Professional | | $87.10 | $138.04 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $50.12 / $63.10
| Professional | 26 | $47.86 | $50.12 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $107.15
| Professional | TC | $87.10 | $87.10 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $263.03 / $416.87
| Professional | | $208.93 | $263.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $81.28 / $128.82
| Professional | 26 | $64.57 | $81.28 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $181.97 / $288.40
| Professional | TC | $144.54 | $181.97 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $74.13 / $107.15
| Facility | 26 | $15.85 | $74.13 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $263.03 / $501.19
| Professional | | $154.88 | $263.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $141.25
| Professional | 26 | $50.12 | $75.86 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $181.97 / $371.54
| Professional | TC | $102.33 | $181.97 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $616.60 / $616.60
| Facility | 26 | $478.63 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $1,698.24
| Professional | | $173.78 | $281.84 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $75.86 / $416.87
| Professional | 26 | $56.23 | $75.86 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $223.87 / $1,412.54
| Professional | TC | $114.82 | $223.87 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $251.19 / $446.68
| Professional | | $165.96 | $251.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $70.79 / $165.96
| Professional | 26 | $56.23 | $70.79 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $186.21 / $331.13
| Professional | TC | $114.82 | $186.21 | $331.13 |