- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $97.72
| Facility | 26 | $83.18 | $83.18 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $169.82 / $380.19
| Professional | | $138.04 | $169.82 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $83.18 / $199.53
| Professional | 26 | $72.44 | $83.18 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $83.18 / $141.25
| Professional | TC | $64.57 | $83.18 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $169.82 / $257.04
| Professional | | $128.82 | $169.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $97.72 / $151.36
| Professional | 26 | $77.62 | $97.72 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $72.44 / $128.82
| Professional | TC | $30.90 | $72.44 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $190.55 / $263.03
| Professional | | $158.49 | $190.55 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $95.50 / $141.25
| Professional | 26 | $83.18 | $95.50 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $93.33 / $125.89
| Professional | TC | $77.62 | $93.33 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $194.98 / $331.13
| Professional | | $131.83 | $194.98 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $109.65 / $173.78
| Professional | 26 | $77.62 | $109.65 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $95.50 / $162.18
| Professional | TC | $43.65 | $95.50 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $354.81 / $354.81
| Facility | 26 | $181.97 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $208.93 / $1,047.13
| Professional | | $138.04 | $208.93 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $117.49 / $512.86
| Professional | 26 | $75.86 | $117.49 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $112.20 / $549.54
| Professional | TC | $47.86 | $112.20 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $186.21 / $316.23
| Professional | | $131.83 | $186.21 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $95.50 / $162.18
| Professional | 26 | $72.44 | $95.50 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $93.33 / $162.18
| Professional | TC | $47.86 | $93.33 | $162.18 |