- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $218.78 / $354.81
| Facility | 26 | $56.23 | $218.78 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $295.12
| Professional | | $114.82 | $151.36 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $54.95 / $112.20
| Professional | 26 | $39.81 | $54.95 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $95.50 / $218.78
| Professional | TC | $72.44 | $95.50 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $69.18
| Professional | 26 | $43.65 | $43.65 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Facility | 26 | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $204.17 / $363.08
| Professional | | $109.65 | $204.17 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $57.54 / $95.50
| Professional | 26 | $33.11 | $57.54 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $141.25 / $239.88
| Professional | TC | $74.13 | $141.25 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $186.21 / $223.87
| Professional | | $134.90 | $186.21 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $60.26 / $74.13
| Professional | 26 | $44.67 | $60.26 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $131.83 / $173.78
| Professional | TC | $104.71 | $131.83 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $128.82 / $234.42
| Professional | | $109.65 | $128.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $75.86
| Professional | 26 | $39.81 | $46.77 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $83.18 / $154.88
| Professional | TC | $70.79 | $83.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $309.03
| Professional | | $112.20 | $173.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $54.95 / $95.50
| Professional | 26 | $36.31 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $213.80
| Professional | TC | $74.13 | $120.23 | $213.80 |