- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $63.10 / $107.15
| Facility | 26 | $33.11 | $63.10 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $147.91 / $436.52
| Professional | | $74.13 | $147.91 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $63.10 / $181.97
| Professional | 26 | $33.11 | $63.10 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $61.66 / $162.18
| Professional | TC | $39.81 | $61.66 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $87.10 / $123.03
| Professional | | $58.88 | $87.10 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $60.26
| Professional | 26 | $28.18 | $38.90 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $50.12 / $60.26
| Professional | TC | $38.02 | $50.12 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $91.20 / $190.55
| Professional | | $44.67 | $91.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $173.78
| Professional | | $74.13 | $117.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $51.29 / $77.62
| Professional | 26 | $30.90 | $51.29 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $69.18 / $102.33
| Professional | TC | $41.69 | $69.18 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $162.18 / $645.65
| Professional | | $97.72 | $162.18 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $66.07 / $281.84
| Professional | 26 | $40.74 | $66.07 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $87.10 / $389.05
| Professional | TC | $54.95 | $87.10 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $104.71 / $112.20
| Professional | | $102.33 | $104.71 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $46.77
| Professional | 26 | $44.67 | $44.67 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $58.88 / $64.57
| Professional | TC | $57.54 | $58.88 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $114.82 / $181.97
| Professional | | $79.43 | $114.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $60.26 / $102.33
| Professional | 26 | $38.90 | $60.26 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $72.44 / $125.89
| Professional | TC | $46.77 | $72.44 | $125.89 |