- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $56.23 / $147.91
| Facility | 26 | $33.11 | $56.23 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $302.00 / $457.09
| Professional | | $239.88 | $302.00 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $42.66 / $81.28
| Professional | 26 | $30.90 | $42.66 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $269.15 / $457.09
| Professional | TC | $213.80 | $269.15 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $389.05 / $588.84
| Professional | | $275.42 | $389.05 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $47.86 / $70.79
| Professional | 26 | $34.67 | $47.86 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $338.84 / $524.81
| Professional | TC | $239.88 | $338.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $338.84 / $741.31
| Professional | | $43.65 | $338.84 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $38.90 / $58.88
| Professional | 26 | $34.67 | $38.90 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $302.00 / $457.09
| Professional | TC | $177.83 | $302.00 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $338.84 / $575.44
| Professional | | $223.87 | $338.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $51.29 / $79.43
| Professional | 26 | $29.51 | $51.29 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $302.00 / $512.86
| Professional | TC | $190.55 | $302.00 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $407.38 / $416.87
| Professional | | $288.40 | $407.38 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $45.71 / $48.98
| Professional | 26 | $35.48 | $45.71 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $354.81 / $371.54
| Professional | TC | $257.04 | $354.81 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $281.84 / $354.81
| Professional | | $251.19 | $281.84 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $57.54 / $77.62
| Professional | 26 | $54.95 | $57.54 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Professional | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $371.54 / $1,778.28
| Professional | | $47.86 | $371.54 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $51.29 / $83.18
| Professional | 26 | $39.81 | $51.29 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $371.54 / $660.69
| Professional | TC | $199.53 | $371.54 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $407.38 / $707.95
| Professional | | $245.47 | $407.38 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $52.48 / $79.43
| Professional | 26 | $31.62 | $52.48 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $363.08 / $630.96
| Professional | TC | $208.93 | $363.08 | $630.96 |