- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $30.20 / $52.48
| Facility | 26 | $28.84 | $30.20 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $141.25 / $616.60
| Professional | | $77.62 | $141.25 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $51.29 / $128.82
| Professional | 26 | $28.18 | $51.29 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $204.17
| Professional | TC | $56.23 | $81.28 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $25.70 / $25.70
| Facility | 26 | $21.38 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $251.19 / $354.81
| Professional | | $169.82 | $251.19 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $75.86 / $107.15
| Professional | 26 | $51.29 | $75.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $190.55 / $251.19
| Professional | TC | $128.82 | $190.55 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $109.65 / $263.03
| Facility | 26 | $48.98 | $109.65 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $194.98 / $309.03
| Professional | | $109.65 | $194.98 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $57.54 / $89.13
| Professional | 26 | $34.67 | $57.54 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $138.04 / $218.78
| Professional | TC | $72.44 | $138.04 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $107.15 / $208.93
| Facility | 26 | $87.10 | $107.15 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $251.19
| Professional | | $154.88 | $154.88 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $74.13
| Professional | 26 | $44.67 | $44.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $177.83
| Professional | TC | $107.15 | $107.15 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Facility | 26 | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $234.42 / $660.69
| Professional | | $97.72 | $234.42 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $75.86 / $213.80
| Professional | 26 | $38.90 | $75.86 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $117.49 / $457.09
| Professional | TC | $56.23 | $117.49 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $794.33
| Professional | | $85.11 | $128.82 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $87.10 / $245.47
| Professional | 26 | $36.31 | $87.10 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $89.13 / $549.54
| Professional | TC | $72.44 | $89.13 | $549.54 |