- 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
- $125.89 / $151.36 / $295.12
| Professional | | $125.89 | $151.36 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $48.98 / $131.83
| Professional | 26 | $38.90 | $48.98 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $107.15 / $186.21
| Professional | TC | $83.18 | $107.15 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $37.15 / $37.15
| Facility | 26 | $30.90 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $338.84 / $489.78
| Professional | | $204.17 | $338.84 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $154.88
| Professional | 26 | $64.57 | $107.15 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $257.04 / $338.84
| Professional | TC | $154.88 | $257.04 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $154.88 / $380.19
| Facility | 26 | $70.79 | $154.88 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $363.08 / $588.84
| Professional | | $181.97 | $363.08 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $114.82 / $181.97
| Professional | 26 | $53.70 | $114.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $257.04 / $407.38
| Professional | TC | $123.03 | $257.04 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $151.36 / $302.00
| Facility | 26 | $123.03 | $151.36 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $346.74 / $537.03
| Professional | | $239.88 | $346.74 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $107.15 / $165.96
| Professional | 26 | $74.13 | $107.15 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $239.88 / $371.54
| Professional | TC | $162.18 | $239.88 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $263.03 / $1,096.48
| Professional | | $144.54 | $263.03 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $85.11 / $446.68
| Professional | 26 | $45.71 | $85.11 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $177.83 / $870.96
| Professional | TC | $95.50 | $177.83 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $251.19 / $457.09
| Professional | | $144.54 | $251.19 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $79.43 / $141.25
| Professional | 26 | $45.71 | $79.43 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $177.83 / $316.23
| Professional | TC | $97.72 | $177.83 | $316.23 |