- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $114.82
| Facility | 26 | $95.50 | $95.50 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $436.52 / $676.08
| Professional | | $245.47 | $436.52 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $125.89 / $346.74
| Professional | 26 | $58.88 | $125.89 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $302.00 / $562.34
| Professional | TC | $177.83 | $302.00 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $165.96 / $323.59
| Professional | | $144.54 | $165.96 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $44.67 / $117.49
| Professional | 26 | $42.66 | $44.67 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $257.04 / $407.38
| Professional | | $213.80 | $257.04 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $56.23 / $93.33
| Professional | 26 | $53.70 | $56.23 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $194.98 / $346.74
| Professional | TC | $162.18 | $194.98 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $416.87 / $724.44
| Professional | | $223.87 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $109.65
| Professional | 26 | $47.86 | $72.44 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $316.23 / $630.96
| Professional | TC | $173.78 | $316.23 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $281.84 / $371.54
| Professional | | $4.90 | $281.84 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.89 / $66.07 / $89.13
| Professional | 26 | $0.89 | $66.07 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $208.93 / $302.00
| Professional | TC | $20.42 | $208.93 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $4.90 / $323.59
| Professional | | $4.90 | $4.90 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.89 / $0.89 / $81.28
| Professional | 26 | $0.89 | $0.89 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.07 / $204.17 / $239.88
| Professional | TC | $4.07 | $204.17 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $213.80 / $229.09
| Professional | | $204.17 | $213.80 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $54.95 / $57.54
| Professional | 26 | $53.70 | $54.95 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $158.49 / $169.82
| Professional | TC | $151.36 | $158.49 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $338.84 / $676.08
| Professional | | $186.21 | $338.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $56.23 / $109.65
| Professional | 26 | $43.65 | $56.23 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $281.84 / $660.69
| Professional | TC | $158.49 | $281.84 | $660.69 |