- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $95.50 / $229.09
| Facility | 26 | $44.67 | $95.50 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $263.03 / $660.69
| Professional | | $169.82 | $263.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $89.13 / $208.93
| Professional | 26 | $51.29 | $89.13 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $173.78 / $436.52
| Professional | TC | $114.82 | $173.78 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $371.54 / $371.54
| Facility | 26 | $134.90 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $316.23 / $1,949.84
| Professional | | $165.96 | $316.23 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $81.28 / $446.68
| Professional | 26 | $51.29 | $81.28 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $257.04 / $1,949.84
| Professional | TC | $123.03 | $257.04 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $467.74 / $794.33
| Professional | | $269.15 | $467.74 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $112.20 / $151.36
| Professional | 26 | $66.07 | $112.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $363.08 / $616.60
| Professional | | $173.78 | $363.08 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $85.11 / $169.82
| Professional | 26 | $47.86 | $85.11 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $275.42 / $467.74
| Professional | TC | $123.03 | $275.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $173.78 / $331.13
| Professional | | $72.44 | $173.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $288.40 / $512.86
| Professional | | $173.78 | $288.40 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $154.88
| Professional | 26 | $57.54 | $85.11 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $186.21 / $316.23
| Professional | TC | $123.03 | $186.21 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $93.33 / $114.82
| Professional | | $56.23 | $93.33 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $371.54 / $371.54
| Facility | 26 | $134.90 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $316.23 / $1,949.84
| Professional | | $165.96 | $316.23 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $81.28 / $446.68
| Professional | 26 | $51.29 | $81.28 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $257.04 / $1,949.84
| Professional | TC | $123.03 | $257.04 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $316.23 / $575.44
| Professional | | $199.53 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $83.18 / $186.21
| Professional | 26 | $57.54 | $83.18 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $218.78 / $426.58
| Professional | TC | $138.04 | $218.78 | $426.58 |