- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $169.82 / $363.08
| Facility | 26 | $50.12 | $169.82 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $194.98 / $501.19
| Professional | | $131.83 | $194.98 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $91.20 / $186.21
| Professional | 26 | $53.70 | $91.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $120.23 / $316.23
| Professional | TC | $79.43 | $120.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $173.78 / $1,023.29
| Professional | | $66.07 | $173.78 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $64.57 / $64.57
| Professional | 26 | $56.23 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $109.65 / $154.88
| Professional | TC | $107.15 | $109.65 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $281.84 / $426.58
| Professional | | $125.89 | $281.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $158.49
| Professional | 26 | $44.67 | $67.61 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $173.78 / $331.13
| Professional | TC | $75.86 | $173.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $154.88 / $331.13
| Professional | | $131.83 | $154.88 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $60.26 / $123.03
| Professional | 26 | $50.12 | $60.26 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $95.50 / $204.17
| Professional | TC | $81.28 | $95.50 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $190.55 / $1,096.48
| Professional | | $95.50 | $190.55 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $194.98 / $354.81
| Professional | 26 | $52.48 | $194.98 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $144.54 / $562.34
| Professional | TC | $81.28 | $144.54 | $562.34 |