- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $69.18 / $154.88
| Facility | 26 | $47.86 | $69.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $131.83 / $588.84
| Professional | | $75.86 | $131.83 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $66.07 / $199.53
| Professional | 26 | $20.89 | $66.07 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $85.11 / $245.47
| Professional | TC | $53.70 | $85.11 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $109.65 / $288.40
| Professional | | $53.70 | $109.65 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $30.90 / $75.86
| Professional | 26 | $14.79 | $30.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $79.43 / $213.80
| Professional | TC | $38.90 | $79.43 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $120.23 / $269.15
| Professional | | $58.88 | $120.23 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $32.36 / $64.57
| Professional | 26 | $15.49 | $32.36 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $89.13 / $199.53
| Professional | TC | $43.65 | $89.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $194.98 / $302.00
| Professional | | $134.90 | $194.98 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $46.77 / $58.88
| Professional | 26 | $33.11 | $46.77 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $147.91 / $169.82
| Professional | TC | $102.33 | $147.91 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $147.91 / $416.87
| Professional | | $91.20 | $147.91 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $38.02 / $97.72
| Professional | 26 | $21.88 | $38.02 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $109.65 / $316.23
| Professional | TC | $69.18 | $109.65 | $316.23 |