- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $58.88 / $95.50
| Facility | 26 | $56.23 | $58.88 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $181.97 / $295.12
| Professional | | $114.82 | $181.97 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $61.66 / $151.36
| Professional | 26 | $50.12 | $61.66 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $120.23 / $208.93
| Professional | TC | $79.43 | $120.23 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $407.38 / $446.68
| Professional | | $309.03 | $407.38 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $128.82 / $141.25
| Professional | 26 | $97.72 | $128.82 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $309.03
| Professional | TC | $208.93 | $275.42 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $338.84 / $416.87
| Professional | | $234.42 | $338.84 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $104.71 / $131.83
| Professional | 26 | $70.79 | $104.71 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $218.78 / $288.40
| Professional | TC | $158.49 | $218.78 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $346.74 / $1,819.70
| Professional | | $199.53 | $346.74 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $112.20 / $537.03
| Professional | 26 | $60.26 | $112.20 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $229.09 / $1,258.93
| Professional | TC | $123.03 | $229.09 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $331.13 / $467.74
| Professional | | $181.97 | $331.13 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $107.15 / $151.36
| Professional | 26 | $53.70 | $107.15 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $223.87 / $316.23
| Professional | TC | $123.03 | $223.87 | $316.23 |