- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $95.50 / $102.33
| Facility | 26 | $54.95 | $95.50 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $104.71 / $288.40
| Professional | | $66.07 | $104.71 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $52.48 / $123.03
| Professional | 26 | $38.02 | $52.48 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $41.69 / $85.11
| Professional | TC | $23.44 | $41.69 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $144.54 / $223.87
| Professional | | $72.44 | $144.54 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $75.86 / $117.49
| Professional | 26 | $46.77 | $75.86 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $69.18 / $112.20
| Professional | TC | $22.91 | $69.18 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $169.82 / $208.93
| Professional | | $138.04 | $169.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $87.10 / $104.71
| Professional | 26 | $69.18 | $87.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $83.18 / $104.71
| Professional | TC | $70.79 | $83.18 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $102.33
| Facility | 26 | $54.95 | $91.20 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $204.17
| Professional | | $87.10 | $128.82 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $77.62 / $107.15
| Professional | 26 | $47.86 | $77.62 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $70.79 / $102.33
| Professional | TC | $43.65 | $70.79 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $51.29 / $85.11
| Professional | | $26.30 | $51.29 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $154.88 / $213.80
| Professional | | $91.20 | $154.88 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $107.15
| Professional | 26 | $51.29 | $77.62 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $53.70 / $102.33
| Professional | TC | $26.92 | $53.70 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Facility | 26 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $169.82 / $229.09
| Professional | | $107.15 | $169.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $87.10 / $117.49
| Professional | 26 | $56.23 | $87.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $83.18 / $112.20
| Professional | TC | $47.86 | $83.18 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $208.93
| Professional | | $89.13 | $138.04 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $85.11 / $117.49
| Professional | 26 | $52.48 | $85.11 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $95.50
| Professional | TC | $32.36 | $57.54 | $95.50 |