- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $66.07 / $177.83
| Facility | 26 | $36.31 | $66.07 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $371.54
| Professional | | $112.20 | $162.18 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $134.90
| Professional | 26 | $41.69 | $61.66 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $234.42
| Professional | TC | $69.18 | $102.33 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $288.40 / $288.40
| Facility | 26 | $104.71 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $1,096.48
| Professional | | $147.91 | $213.80 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $288.40
| Professional | 26 | $40.74 | $63.10 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $158.49 / $812.83
| Professional | TC | $102.33 | $158.49 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $85.11 / $117.49
| Professional | 26 | $51.29 | $85.11 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $223.87 / $426.58
| Professional | | $112.20 | $223.87 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $66.07 / $134.90
| Professional | 26 | $38.02 | $66.07 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $165.96 / $302.00
| Professional | TC | $75.86 | $165.96 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $128.82 / $251.19
| Professional | | $57.54 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $363.08
| Professional | | $134.90 | $204.17 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $67.61 / $123.03
| Professional | 26 | $45.71 | $67.61 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $138.04 / $239.88
| Professional | TC | $95.50 | $138.04 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $72.44 / $112.20
| Professional | | $69.18 | $72.44 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $288.40 / $288.40
| Facility | 26 | $104.71 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $1,096.48
| Professional | | $147.91 | $213.80 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $288.40
| Professional | 26 | $40.74 | $63.10 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $158.49 / $812.83
| Professional | TC | $102.33 | $158.49 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $208.93 / $416.87
| Professional | | $147.91 | $208.93 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $64.57 / $147.91
| Professional | 26 | $44.67 | $64.57 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $288.40
| Professional | TC | $97.72 | $144.54 | $288.40 |