- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $48.98 / $67.61
| Facility | 26 | $44.67 | $48.98 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $295.12 / $630.96
| Professional | | $218.78 | $295.12 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $54.95 / $95.50
| Professional | 26 | $33.11 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $234.42 / $380.19
| Professional | TC | $173.78 | $234.42 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $213.80 / $239.88
| Professional | | $199.53 | $213.80 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $53.70
| Professional | 26 | $28.18 | $44.67 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $181.97 / $338.84
| Professional | | $173.78 | $181.97 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $46.77 / $75.86
| Professional | 26 | $38.02 | $46.77 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $141.25 / $257.04
| Professional | TC | $128.82 | $141.25 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $234.42 / $316.23
| Professional | | $38.90 | $234.42 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $269.15 / $457.09
| Professional | | $186.21 | $269.15 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $81.28
| Professional | 26 | $37.15 | $48.98 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $251.19 / $389.05
| Professional | TC | $147.91 | $251.19 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $281.84 / $562.34
| Professional | | $169.82 | $281.84 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $42.66 / $79.43
| Professional | 26 | $33.88 | $42.66 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $239.88 / $436.52
| Professional | TC | $134.90 | $239.88 | $436.52 |