- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $44.67 / $58.88
| Facility | 26 | $35.48 | $44.67 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $309.03 / $537.03
| Professional | | $239.88 | $309.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $47.86 / $117.49
| Professional | 26 | $30.20 | $47.86 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $275.42 / $478.63
| Professional | TC | $213.80 | $275.42 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $426.58 / $616.60
| Professional | | $281.84 | $426.58 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $46.77 / $67.61
| Professional | 26 | $32.36 | $46.77 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $380.19 / $549.54
| Professional | TC | $245.47 | $380.19 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $426.58 / $741.31
| Professional | | $309.03 | $426.58 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $45.71 / $81.28
| Professional | 26 | $33.11 | $45.71 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $380.19 / $660.69
| Professional | TC | $275.42 | $380.19 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,148.15 / $1,148.15
| Professional | | $426.58 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $125.89 / $125.89
| Professional | 26 | $48.98 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $1,023.29 / $1,023.29
| Professional | TC | $380.19 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $302.00 / $323.59
| Professional | | $288.40 | $302.00 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $35.48
| Professional | 26 | $33.88 | $33.88 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $269.15 / $288.40
| Professional | TC | $251.19 | $269.15 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $457.09 / $758.58
| Professional | | $295.12 | $457.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $58.88 / $93.33
| Professional | 26 | $31.62 | $58.88 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $407.38 / $676.08
| Professional | TC | $263.03 | $407.38 | $676.08 |