- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $61.66 / $181.97
| Facility | 26 | $25.12 | $61.66 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $114.82 / $275.42
| Professional | | $85.11 | $114.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $75.86
| Professional | 26 | $22.91 | $32.36 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $75.86 / $147.91
| Professional | TC | $61.66 | $75.86 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $112.20 / $346.74
| Professional | | $30.20 | $112.20 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $32.36
| Professional | 26 | $26.92 | $26.92 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $87.10 / $89.13
| Professional | TC | $81.28 | $87.10 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $251.19
| Professional | | $85.11 | $125.89 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $33.88 / $64.57
| Professional | 26 | $22.39 | $33.88 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $91.20 / $181.97
| Professional | TC | $61.66 | $91.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $131.83 / $245.47
| Professional | | $109.65 | $131.83 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $31.62 / $61.66
| Professional | 26 | $26.92 | $31.62 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $97.72 / $186.21
| Professional | TC | $83.18 | $97.72 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $107.15 / $691.83
| Professional | | $93.33 | $107.15 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $93.33 / $177.83
| Professional | 26 | $25.70 | $93.33 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $95.50 / $269.15
| Professional | TC | $67.61 | $95.50 | $269.15 |