- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $177.83
| Facility | 26 | $81.28 | $81.28 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $134.90 / $363.08
| Professional | | $85.11 | $134.90 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $30.20 / $93.33
| Professional | 26 | $19.95 | $30.20 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $104.71 / $245.47
| Professional | TC | $67.61 | $104.71 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $204.17 / $380.19
| Professional | | $85.11 | $204.17 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $42.66 / $87.10
| Professional | 26 | $28.84 | $42.66 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $134.90 / $295.12
| Professional | TC | $56.23 | $134.90 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $177.83
| Facility | 26 | $81.28 | $81.28 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $323.59 / $676.08
| Professional | | $123.03 | $323.59 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $74.13 / $134.90
| Professional | 26 | $26.30 | $74.13 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $251.19 / $467.74
| Professional | TC | $93.33 | $251.19 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $501.19 / $812.83
| Professional | | $467.74 | $501.19 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $102.33 / $165.96
| Professional | 26 | $93.33 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $407.38 / $645.65
| Professional | TC | $354.81 | $407.38 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $309.03 / $380.19
| Professional | | $120.23 | $309.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $36.31 / $93.33
| Professional | 26 | $21.38 | $36.31 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $134.90 / $295.12
| Professional | TC | $58.88 | $134.90 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $309.03 / $616.60
| Professional | | $120.23 | $309.03 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $74.13 / $147.91
| Professional | 26 | $28.18 | $74.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $234.42 / $467.74
| Professional | TC | $85.11 | $234.42 | $467.74 |