- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $223.87
| Facility | 26 | $52.48 | $75.86 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $213.80 / $512.86
| Professional | | $128.82 | $213.80 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $61.66 / $154.88
| Professional | 26 | $42.66 | $61.66 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $120.23 / $331.13
| Professional | TC | $81.28 | $120.23 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Professional | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $37.15 / $77.62
| Professional | 26 | $34.67 | $37.15 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $144.54
| Professional | TC | $60.26 | $60.26 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $186.21 / $436.52
| Professional | | $147.91 | $186.21 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $63.10 / $112.20
| Professional | 26 | $50.12 | $63.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $125.89 / $338.84
| Professional | TC | $95.50 | $125.89 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $141.25 / $229.09
| Professional | | $134.90 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $52.48 / $70.79
| Professional | 26 | $50.12 | $52.48 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $91.20 / $165.96
| Professional | TC | $83.18 | $91.20 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $53.70 / $75.86
| Facility | 26 | $11.48 | $53.70 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $223.87 / $436.52
| Professional | | $120.23 | $223.87 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $66.07 / $123.03
| Professional | 26 | $41.69 | $66.07 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $158.49 / $331.13
| Professional | TC | $77.62 | $158.49 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $446.68 / $446.68
| Facility | 26 | $338.84 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $269.15 / $1,621.81
| Professional | | $151.36 | $269.15 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $70.79 / $380.19
| Professional | 26 | $47.86 | $70.79 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $204.17 / $1,318.26
| Professional | TC | $97.72 | $204.17 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $208.93 / $354.81
| Professional | | $128.82 | $208.93 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $60.26 / $123.03
| Professional | 26 | $45.71 | $60.26 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $134.90 / $251.19
| Professional | TC | $93.33 | $134.90 | $251.19 |