- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $93.33
| Facility | 26 | $60.26 | $60.26 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $109.65 / $199.53
| Professional | | $91.20 | $109.65 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $63.10 / $138.04
| Professional | 26 | $53.70 | $63.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $48.98 / $120.23
| Professional | TC | $29.51 | $48.98 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $208.93 / $257.04
| Professional | | $173.78 | $208.93 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $117.49 / $144.54
| Professional | 26 | $102.33 | $117.49 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $91.20 / $114.82
| Professional | TC | $72.44 | $91.20 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $158.49 / $741.31
| Professional | | $87.10 | $158.49 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $104.71 / $354.81
| Professional | 26 | $57.54 | $104.71 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $45.71 / $288.40
| Professional | TC | $28.84 | $45.71 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $186.21 / $239.88
| Professional | | $165.96 | $186.21 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $128.82 / $138.04
| Professional | 26 | $114.82 | $128.82 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $56.23 / $102.33
| Professional | TC | $48.98 | $56.23 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $162.18 / $162.18
| Professional | | $87.10 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $120.23 / $120.23
| Professional | 26 | $60.26 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $43.65 / $43.65
| Professional | TC | $26.30 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $138.04 / $190.55
| Professional | | $102.33 | $138.04 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $91.20 / $112.20
| Professional | 26 | $61.66 | $91.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $60.26 / $81.28
| Professional | TC | $36.31 | $60.26 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $158.49 / $229.09
| Professional | | $89.13 | $158.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $104.71 / $151.36
| Professional | 26 | $57.54 | $104.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $50.12 / $91.20
| Professional | TC | $28.84 | $50.12 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $199.53 / $234.42
| Professional | | $194.98 | $199.53 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $114.82 / $134.90
| Professional | 26 | $109.65 | $114.82 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $87.10 / $102.33
| Professional | TC | $83.18 | $87.10 | $102.33 |