- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $138.04 / $407.38
| Facility | 26 | $75.86 | $138.04 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $89.13 / $251.19
| Professional | | $51.29 | $89.13 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $41.69 / $120.23
| Professional | 26 | $22.91 | $41.69 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.00 / $30.20 / $97.72
| Professional | TC | $10.00 | $30.20 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $128.82 / $239.88
| Professional | | $69.18 | $128.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $53.70 / $128.82
| Professional | 26 | $33.88 | $53.70 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $83.18 / $131.83
| Professional | TC | $14.79 | $83.18 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $138.04 / $407.38
| Facility | 26 | $75.86 | $138.04 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $162.18 / $323.59
| Professional | | $79.43 | $162.18 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $123.03 / $213.80
| Professional | 26 | $41.69 | $123.03 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $91.20
| Professional | TC | $25.12 | $34.67 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $295.12 / $489.78
| Professional | | $218.78 | $295.12 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $173.78 / $213.80
| Professional | 26 | $117.49 | $173.78 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $128.82 / $346.74
| Professional | TC | $44.67 | $128.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $120.23 / $177.83
| Professional | | $79.43 | $120.23 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $128.82
| Professional | 26 | $30.20 | $42.66 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $45.71 / $131.83
| Professional | TC | $18.62 | $45.71 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $194.98 / $407.38
| Professional | | $79.43 | $194.98 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $89.13 / $186.21
| Professional | 26 | $33.88 | $89.13 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $144.54 / $239.88
| Professional | TC | $21.88 | $144.54 | $239.88 |