- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $63.10 / $85.11
| Facility | 26 | $43.65 | $63.10 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $204.17 / $371.54
| Professional | | $173.78 | $204.17 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $43.65 / $81.28
| Professional | 26 | $38.02 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $165.96 / $288.40
| Professional | TC | $131.83 | $165.96 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $52.48 / $58.88
| Professional | 26 | $33.88 | $52.48 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $245.47 / $398.11
| Professional | | $208.93 | $245.47 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $52.48 / $89.13
| Professional | 26 | $44.67 | $52.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $194.98 / $309.03
| Professional | TC | $165.96 | $194.98 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $57.54 / $69.18
| Professional | | $42.66 | $57.54 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $51.29 / $74.13
| Facility | 26 | $10.96 | $51.29 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $446.68 / $1,122.02
| Professional | | $281.84 | $446.68 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $234.42
| Professional | 26 | $57.54 | $91.20 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $363.08 / $758.58
| Professional | TC | $229.09 | $363.08 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $208.93
| Professional | | $32.36 | $33.11 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $269.15 / $354.81
| Professional | | $223.87 | $269.15 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $57.54 / $74.13
| Professional | 26 | $43.65 | $57.54 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $218.78 / $288.40
| Professional | TC | $181.97 | $218.78 | $288.40 |