- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $97.72 / $147.91
| Facility | 26 | $81.28 | $97.72 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $173.78 / $316.23
| Professional | | $128.82 | $173.78 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $87.10 / $138.04
| Professional | 26 | $57.54 | $87.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $218.78
| Professional | TC | $52.48 | $79.43 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Professional | | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $91.20 / $95.50
| Professional | 26 | $74.13 | $91.20 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $213.80 / $275.42
| Professional | | $186.21 | $213.80 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $120.23 / $151.36
| Professional | 26 | $104.71 | $120.23 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $93.33 / $120.23
| Professional | TC | $81.28 | $93.33 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $104.71 / $151.36
| Facility | 26 | $22.39 | $104.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $288.40 / $812.83
| Professional | | $151.36 | $288.40 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $169.82
| Professional | 26 | $61.66 | $95.50 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $138.04 / $549.54
| Professional | TC | $67.61 | $138.04 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $309.03
| Professional | | $131.83 | $131.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $144.54 / $181.97
| Professional | 26 | $77.62 | $144.54 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $263.03 / $616.60
| Professional | | $162.18 | $263.03 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $181.97
| Professional | 26 | $66.07 | $97.72 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $123.03 / $446.68
| Professional | TC | $72.44 | $123.03 | $446.68 |