- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $91.20 / $95.50
| Facility | 26 | $52.48 | $91.20 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $169.82 / $467.74
| Professional | | $87.10 | $169.82 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $60.26 / $151.36
| Professional | 26 | $33.11 | $60.26 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $74.13 / $208.93
| Professional | TC | $47.86 | $74.13 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $169.82 / $208.93
| Professional | | $144.54 | $169.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $67.61 / $75.86
| Professional | 26 | $57.54 | $67.61 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $102.33 / $120.23
| Professional | TC | $85.11 | $102.33 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $141.25 / $245.47
| Professional | | $93.33 | $141.25 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $56.23 / $85.11
| Professional | 26 | $35.48 | $56.23 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $87.10 / $147.91
| Professional | TC | $53.70 | $87.10 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $338.84 / $338.84
| Professional | | $257.04 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $181.97 / $181.97
| Professional | 26 | $154.88 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $154.88
| Professional | TC | $100.00 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $91.20 / $95.50
| Facility | 26 | $52.48 | $91.20 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $169.82 / $263.03
| Professional | | $97.72 | $169.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $66.07 / $112.20
| Professional | 26 | $37.15 | $66.07 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $158.49
| Professional | TC | $64.57 | $107.15 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.11 / $70.79
| Professional | | $28.18 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $186.21 / $199.53
| Professional | | $144.54 | $186.21 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $72.44 / $75.86
| Professional | 26 | $54.95 | $72.44 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $114.82 / $120.23
| Professional | TC | $89.13 | $114.82 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $199.53
| Professional | | $87.10 | $87.10 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $74.13
| Professional | 26 | $33.88 | $33.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $57.54 / $112.20
| Professional | TC | $52.48 | $57.54 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $104.71 / $208.93
| Professional | | $97.72 | $104.71 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $41.69 / $77.62
| Professional | 26 | $37.15 | $41.69 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $69.18 / $134.90
| Professional | TC | $58.88 | $69.18 | $134.90 |