- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $97.72 / $107.15
| Facility | 26 | $64.57 | $97.72 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $181.97 / $794.33
| Professional | | $109.65 | $181.97 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $97.72 / $812.83
| Professional | 26 | $53.70 | $97.72 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $72.44 / $123.03
| Professional | TC | $52.48 | $72.44 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $147.91
| Professional | | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $67.61 / $93.33
| Professional | 26 | $47.86 | $67.61 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $186.21 / $208.93
| Professional | | $144.54 | $186.21 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $93.33 / $104.71
| Professional | 26 | $70.79 | $93.33 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $93.33 / $104.71
| Professional | TC | $74.13 | $93.33 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $61.66 / $61.66
| Professional | 26 | $39.81 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $147.91 / $281.84
| Professional | | $87.10 | $147.91 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $70.79 / $125.89
| Professional | 26 | $41.69 | $70.79 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $74.13 / $147.91
| Professional | TC | $42.66 | $74.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $147.91 / $223.87
| Professional | | $109.65 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $63.10 / $95.50
| Professional | 26 | $50.12 | $63.10 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $75.86 / $134.90
| Professional | TC | $57.54 | $75.86 | $134.90 |