- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $75.86 / $218.78
| Facility | 26 | $41.69 | $75.86 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $239.88 / $588.84
| Professional | | $123.03 | $239.88 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $91.20 / $177.83
| Professional | 26 | $48.98 | $91.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $190.55 / $436.52
| Professional | TC | $131.83 | $190.55 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $346.74 / $346.74
| Facility | 26 | $128.82 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $323.59 / $1,737.80
| Professional | | $190.55 | $323.59 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $75.86 / $346.74
| Professional | 26 | $48.98 | $75.86 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $257.04 / $1,380.38
| Professional | TC | $154.88 | $257.04 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $575.44 / $954.99
| Professional | | $331.13 | $575.44 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $107.15 / $141.25
| Professional | 26 | $61.66 | $107.15 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $354.81 / $660.69
| Professional | | $177.83 | $354.81 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $79.43 / $162.18
| Professional | 26 | $45.71 | $79.43 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $275.42 / $512.86
| Professional | TC | $128.82 | $275.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $213.80 / $398.11
| Professional | | $67.61 | $213.80 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $331.13 / $630.96
| Professional | | $218.78 | $331.13 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $83.18 / $144.54
| Professional | 26 | $54.95 | $83.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $234.42 / $407.38
| Professional | TC | $162.18 | $234.42 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $87.10 / $112.20
| Professional | | $77.62 | $87.10 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $346.74 / $346.74
| Facility | 26 | $128.82 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $323.59 / $1,737.80
| Professional | | $190.55 | $323.59 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $75.86 / $346.74
| Professional | 26 | $48.98 | $75.86 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $257.04 / $1,380.38
| Professional | TC | $154.88 | $257.04 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $323.59 / $724.44
| Professional | | $218.78 | $323.59 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $79.43 / $194.98
| Professional | 26 | $53.70 | $79.43 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $245.47 / $478.63
| Professional | TC | $165.96 | $245.47 | $478.63 |