- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $44.67
| Facility | 26 | $25.70 | $25.70 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $112.20 / $416.87
| Professional | | $81.28 | $112.20 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $89.13
| Professional | 26 | $21.88 | $34.67 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $169.82
| Professional | TC | $60.26 | $81.28 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $21.88
| Facility | 26 | $18.20 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $269.15 / $380.19
| Professional | | $181.97 | $269.15 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $64.57 / $93.33
| Professional | 26 | $44.67 | $64.57 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $218.78 / $288.40
| Professional | TC | $151.36 | $218.78 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $93.33 / $223.87
| Facility | 26 | $41.69 | $93.33 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $204.17 / $323.59
| Professional | | $107.15 | $204.17 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $47.86 / $75.86
| Professional | 26 | $30.90 | $47.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $158.49 / $251.19
| Professional | TC | $77.62 | $158.49 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $91.20 / $177.83
| Facility | 26 | $72.44 | $91.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $269.15
| Professional | | $162.18 | $162.18 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $63.10
| Professional | 26 | $38.02 | $38.02 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $208.93
| Professional | TC | $125.89 | $125.89 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Facility | 26 | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $190.55 / $588.84
| Professional | | $104.71 | $190.55 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $52.48 / $151.36
| Professional | 26 | $28.18 | $52.48 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $128.82 / $524.81
| Professional | TC | $75.86 | $128.82 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $141.25 / $870.96
| Professional | | $85.11 | $141.25 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $85.11 / $213.80
| Professional | 26 | $32.36 | $85.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $125.89 / $257.04
| Professional | TC | $81.28 | $125.89 | $257.04 |