- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $97.72 / $173.78
| Facility | 26 | $61.66 | $97.72 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $117.49 / $229.09
| Professional | | $83.18 | $117.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $151.36
| Professional | 26 | $51.29 | $72.44 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $43.65 / $74.13
| Professional | TC | $26.92 | $43.65 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $87.10 / $190.55
| Professional | | $72.44 | $87.10 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $74.13 / $83.18
| Professional | 26 | $72.44 | $74.13 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $109.65 / $186.21
| Professional | | $87.10 | $109.65 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $125.89
| Professional | 26 | $56.23 | $74.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $35.48 / $60.26
| Professional | TC | $27.54 | $35.48 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $83.18 / $141.25
| Professional | | $38.02 | $83.18 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $63.10 / $89.13
| Facility | 26 | $13.49 | $63.10 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $120.23 / $194.98
| Professional | | $85.11 | $120.23 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $125.89
| Professional | 26 | $54.95 | $75.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $44.67 / $81.28
| Professional | TC | $26.92 | $44.67 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $63.10 / $89.13
| Facility | 26 | $13.49 | $63.10 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $117.49 / $181.97
| Professional | | $79.43 | $117.49 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $114.82
| Professional | 26 | $54.95 | $75.86 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $43.65 / $74.13
| Professional | TC | $26.30 | $43.65 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $74.13
| Professional | | $32.36 | $33.11 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Facility | 26 | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $112.20 / $154.88
| Professional | | $89.13 | $112.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $64.57 / $91.20
| Professional | 26 | $52.48 | $64.57 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $45.71 / $63.10
| Professional | TC | $37.15 | $45.71 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $181.97
| Professional | | $70.79 | $100.00 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $66.07 / $114.82
| Professional | 26 | $47.86 | $66.07 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $66.07
| Professional | TC | $21.88 | $33.88 | $66.07 |