- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $41.69 / $44.67
| Facility | 26 | $28.84 | $41.69 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $125.89 / $489.78
| Professional | | $67.61 | $125.89 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $26.30 / $70.79
| Professional | 26 | $15.14 | $26.30 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $97.72 / $199.53
| Professional | TC | $63.10 | $97.72 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.47 / $20.89 / $29.51
| Facility | 26 | $4.47 | $20.89 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $190.55 / $281.84
| Professional | | $93.33 | $190.55 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $33.11 / $51.29
| Professional | 26 | $19.50 | $33.11 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $154.88 / $234.42
| Professional | TC | $77.62 | $154.88 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $218.78 / $263.03
| Professional | | $190.55 | $218.78 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $38.02 / $45.71
| Professional | 26 | $33.11 | $38.02 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $181.97 / $218.78
| Professional | TC | $158.49 | $181.97 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $39.81 / $44.67
| Facility | 26 | $23.99 | $39.81 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $199.53 / $295.12
| Professional | | $117.49 | $199.53 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $36.31 / $56.23
| Professional | 26 | $17.78 | $36.31 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $165.96 / $234.42
| Professional | TC | $97.72 | $165.96 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $57.54 / $194.98
| Professional | | $26.30 | $57.54 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $204.17 / $281.84
| Professional | | $144.54 | $204.17 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $37.15 / $51.29
| Professional | 26 | $24.55 | $37.15 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $162.18 / $234.42
| Professional | TC | $97.72 | $162.18 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $281.84
| Professional | | $147.91 | $213.80 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $51.29
| Professional | 26 | $32.36 | $38.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $173.78 / $234.42
| Professional | TC | $120.23 | $173.78 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $263.03
| Professional | | $79.43 | $112.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $22.39 / $50.12
| Professional | 26 | $17.78 | $22.39 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $97.72 / $213.80
| Professional | TC | $63.10 | $97.72 | $213.80 |