- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $109.65 / $134.90
| Facility | 26 | $63.10 | $109.65 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $239.88 / $812.83
| Professional | | $181.97 | $239.88 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $47.86 / $112.20
| Professional | 26 | $27.54 | $47.86 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $181.97 / $426.58
| Professional | TC | $144.54 | $181.97 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $218.78
| Professional | | $194.98 | $194.98 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $28.84 / $36.31
| Professional | 26 | $28.18 | $28.84 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $223.87 / $398.11
| Professional | | $199.53 | $223.87 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $41.69 / $74.13
| Professional | 26 | $37.15 | $41.69 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $181.97 / $316.23
| Professional | TC | $158.49 | $181.97 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $269.15 / $446.68
| Professional | | $190.55 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $38.90 / $87.10
| Professional | 26 | $23.99 | $38.90 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $223.87 / $371.54
| Professional | TC | $154.88 | $223.87 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $169.82 / $169.82
| Facility | 26 | $87.10 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $281.84 / $1,548.82
| Professional | | $190.55 | $281.84 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $41.69 / $389.05
| Professional | 26 | $22.91 | $41.69 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $245.47 / $1,412.54
| Professional | TC | $154.88 | $245.47 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $245.47 / $389.05
| Professional | | $181.97 | $245.47 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $38.02 / $67.61
| Professional | 26 | $22.39 | $38.02 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $331.13
| Professional | TC | $147.91 | $213.80 | $331.13 |