- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $45.71 / $208.93
| Facility | 26 | $33.11 | $45.71 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $128.82 / $281.84
| Professional | | $66.07 | $128.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $45.71 / $97.72
| Professional | 26 | $33.11 | $45.71 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $93.33 / $177.83
| Professional | TC | $70.79 | $93.33 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $275.42
| Professional | | $87.10 | $134.90 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $89.13
| Professional | 26 | $28.84 | $38.02 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $165.96
| Professional | TC | $117.49 | $117.49 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $141.25 / $263.03
| Professional | | $85.11 | $141.25 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $56.23 / $93.33
| Professional | 26 | $37.15 | $56.23 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $125.89 / $204.17
| Professional | TC | $81.28 | $125.89 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Facility | 26 | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $162.18 / $269.15
| Professional | | $107.15 | $162.18 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $52.48 / $87.10
| Professional | 26 | $33.88 | $52.48 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $186.21
| Professional | TC | $75.86 | $112.20 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Facility | 26 | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,047.13 / $1,047.13
| Professional | | $812.83 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $309.03 / $309.03
| Professional | 26 | $239.88 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $562.34 / $741.31 / $741.31
| Professional | TC | $562.34 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $162.18 / $251.19
| Professional | | $123.03 | $162.18 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $50.12 / $83.18
| Professional | 26 | $38.02 | $50.12 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $109.65 / $169.82
| Professional | TC | $85.11 | $109.65 | $169.82 |