- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $85.11
| Facility | 26 | $42.66 | $42.66 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $398.11 / $1,905.46
| Professional | | $288.40 | $398.11 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $63.10 / $144.54
| Professional | 26 | $41.69 | $63.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $323.59 / $870.96
| Professional | TC | $245.47 | $323.59 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $346.74 / $389.05
| Professional | | $51.29 | $346.74 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $52.48 / $57.54
| Professional | 26 | $46.77 | $52.48 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $331.13 / $338.84
| Professional | TC | $295.12 | $331.13 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $371.54 / $676.08
| Professional | | $275.42 | $371.54 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $93.33
| Professional | 26 | $38.02 | $54.95 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $323.59 / $691.83
| Professional | TC | $229.09 | $323.59 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $416.87 / $724.44
| Professional | | $338.84 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $58.88 / $93.33
| Professional | 26 | $48.98 | $58.88 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $354.81 / $630.96
| Professional | TC | $295.12 | $354.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $776.25
| Professional | | $269.15 | $389.05 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $48.98 / $102.33
| Professional | 26 | $40.74 | $48.98 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $338.84 / $676.08
| Professional | TC | $223.87 | $338.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $416.87 / $562.34
| Professional | | $281.84 | $416.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $58.88 / $74.13
| Professional | 26 | $39.81 | $58.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $354.81 / $489.78
| Professional | TC | $245.47 | $354.81 | $489.78 |