- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $131.83 / $331.13
| Facility | 26 | $45.71 | $131.83 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $190.55 / $630.96
| Professional | | $128.82 | $190.55 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $83.18 / $165.96
| Professional | 26 | $50.12 | $83.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $114.82 / $281.84
| Professional | TC | $79.43 | $114.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $169.82 / $1,071.52
| Professional | | $79.43 | $169.82 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $67.61
| Professional | 26 | $60.26 | $60.26 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $141.25
| Professional | TC | $109.65 | $109.65 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $281.84 / $426.58
| Professional | | $123.03 | $281.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $61.66 / $144.54
| Professional | 26 | $40.74 | $61.66 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $177.83 / $338.84
| Professional | TC | $77.62 | $177.83 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $151.36 / $316.23
| Professional | | $128.82 | $151.36 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $53.70 / $112.20
| Professional | 26 | $45.71 | $53.70 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $97.72 / $204.17
| Professional | TC | $83.18 | $97.72 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $190.55 / $1,071.52
| Professional | | $95.50 | $190.55 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $109.65 / $316.23
| Professional | 26 | $47.86 | $109.65 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $151.36 / $562.34
| Professional | TC | $83.18 | $151.36 | $562.34 |