- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $56.23 / $147.91
| Facility | 26 | $28.84 | $56.23 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $154.88 / $288.40
| Professional | | $112.20 | $154.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $50.12 / $229.09
| Professional | 26 | $31.62 | $50.12 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $114.82 / $309.03
| Professional | TC | $81.28 | $114.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $83.18 / $85.11
| Professional | | $77.62 | $83.18 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $69.18 / $190.55
| Professional | 26 | $19.50 | $69.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $134.90 / $263.03
| Professional | | $74.13 | $134.90 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $52.48 / $93.33
| Professional | 26 | $22.39 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $69.18 / $173.78
| Professional | TC | $50.12 | $69.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $147.91 / $208.93
| Professional | | $46.77 | $147.91 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $398.11
| Professional | | $70.79 | $89.13 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $30.20 / $120.23
| Professional | 26 | $20.42 | $30.20 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $69.18 / $346.74
| Professional | TC | $42.66 | $69.18 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $257.04 / $549.54
| Professional | | $154.88 | $257.04 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $61.66 / $223.87
| Professional | 26 | $36.31 | $61.66 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $194.98 / $398.11
| Professional | TC | $117.49 | $194.98 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $158.49 / $316.23
| Professional | | $42.66 | $158.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $165.96 / $354.81
| Professional | | $102.33 | $165.96 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $46.77 / $97.72
| Professional | 26 | $27.54 | $46.77 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $117.49 / $269.15
| Professional | TC | $67.61 | $117.49 | $269.15 |