- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $46.77 / $56.23
| Facility | 26 | $43.65 | $46.77 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $229.09 / $562.34
| Professional | | $181.97 | $229.09 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $47.86 / $120.23
| Professional | 26 | $28.18 | $47.86 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $181.97 / $398.11
| Professional | TC | $144.54 | $181.97 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $199.53
| Professional | | $147.91 | $147.91 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $48.98 / $66.07
| Professional | 26 | $30.20 | $48.98 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $295.12 / $316.23
| Professional | | $56.23 | $295.12 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | 26 | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $251.19 / $575.44
| Professional | | $177.83 | $251.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $40.74 / $117.49
| Professional | 26 | $24.55 | $40.74 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $213.80 / $512.86
| Professional | TC | $158.49 | $213.80 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $56.23 / $66.07
| Facility | 26 | $29.51 | $56.23 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $251.19 / $489.78
| Professional | | $186.21 | $251.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $43.65 / $95.50
| Professional | 26 | $23.99 | $43.65 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $223.87 / $389.05
| Professional | TC | $151.36 | $223.87 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $218.78 / $398.11
| Professional | | $173.78 | $218.78 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $40.74 / $67.61
| Professional | 26 | $24.55 | $40.74 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $186.21 / $363.08
| Professional | TC | $151.36 | $186.21 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $251.19 / $389.05
| Professional | | $194.98 | $251.19 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $39.81 / $64.57
| Professional | 26 | $23.99 | $39.81 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $213.80 / $323.59
| Professional | TC | $162.18 | $213.80 | $323.59 |