- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $138.04 / $147.91
| Facility | 26 | $75.86 | $138.04 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $158.49 / $363.08
| Professional | | $107.15 | $158.49 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $69.18 / $158.49
| Professional | 26 | $52.48 | $69.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $67.61 / $169.82
| Professional | TC | $52.48 | $67.61 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $229.09 / $380.19
| Professional | | $131.83 | $229.09 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $109.65 / $165.96
| Professional | 26 | $64.57 | $109.65 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $128.82 / $223.87
| Professional | TC | $66.07 | $128.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $263.03 / $316.23
| Professional | | $234.42 | $263.03 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $125.89 / $151.36
| Professional | 26 | $114.82 | $125.89 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $131.83 / $162.18
| Professional | TC | $117.49 | $131.83 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $134.90 / $147.91
| Facility | 26 | $75.86 | $134.90 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $245.47 / $338.84
| Professional | | $181.97 | $245.47 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $123.03 / $173.78
| Professional | 26 | $70.79 | $123.03 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $131.83 / $190.55
| Professional | TC | $81.28 | $131.83 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $102.33 / $162.18
| Professional | | $70.79 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $257.04 / $346.74
| Professional | | $199.53 | $257.04 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $120.23 / $162.18
| Professional | 26 | $81.28 | $120.23 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $134.90 / $208.93
| Professional | TC | $89.13 | $134.90 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | 26 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $275.42 / $338.84
| Professional | | $223.87 | $275.42 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $131.83 / $169.82
| Professional | 26 | $109.65 | $131.83 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $138.04 / $173.78
| Professional | TC | $112.20 | $138.04 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $223.87 / $354.81
| Professional | | $125.89 | $223.87 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $109.65 / $165.96
| Professional | 26 | $58.88 | $109.65 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $114.82 / $190.55
| Professional | TC | $61.66 | $114.82 | $190.55 |