- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $63.10
| Facility | 26 | $50.12 | $50.12 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $380.19
| Professional | | $109.65 | $162.18 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $60.26 / $120.23
| Professional | 26 | $31.62 | $60.26 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $208.93
| Professional | TC | $75.86 | $104.71 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $39.81 / $81.28
| Professional | 26 | $33.11 | $39.81 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $204.17 / $218.78
| Professional | | $141.25 | $204.17 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $91.20
| Professional | 26 | $67.61 | $67.61 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | TC | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $112.20 / $190.55
| Professional | | $46.77 | $112.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $154.88 / $323.59
| Professional | | $102.33 | $154.88 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $51.29 / $104.71
| Professional | 26 | $30.20 | $51.29 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $114.82 / $263.03
| Professional | TC | $70.79 | $114.82 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $51.29 / $72.44
| Facility | 26 | $50.12 | $51.29 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $323.59
| Professional | | $109.65 | $162.18 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $51.29 / $114.82
| Professional | 26 | $30.20 | $51.29 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $109.65 / $213.80
| Professional | TC | $79.43 | $109.65 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $138.04 / $223.87
| Professional | | $102.33 | $138.04 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $40.74 / $72.44
| Professional | 26 | $30.90 | $40.74 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $102.33 / $186.21
| Professional | TC | $66.07 | $102.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $134.90 / $338.84
| Professional | | $95.50 | $134.90 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $45.71 / $204.17
| Professional | 26 | $33.88 | $45.71 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $95.50 / $165.96
| Professional | TC | $79.43 | $95.50 | $165.96 |