- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $151.36 / $181.97
| Facility | 26 | $104.71 | $151.36 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $162.18 / $549.54
| Professional | | $123.03 | $162.18 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $52.48 / $173.78
| Professional | 26 | $39.81 | $52.48 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $109.65 / $263.03
| Professional | TC | $81.28 | $109.65 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $147.91 / $263.03
| Professional | | $131.83 | $147.91 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $57.54 / $102.33
| Professional | 26 | $51.29 | $57.54 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $158.49
| Professional | TC | $79.43 | $89.13 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $190.55 / $309.03
| Professional | | $138.04 | $190.55 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $56.23 / $102.33
| Professional | 26 | $42.66 | $56.23 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $134.90 / $218.78
| Professional | TC | $93.33 | $134.90 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $213.80 / $213.80
| Facility | 26 | $102.33 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $199.53 / $1,096.48
| Professional | | $123.03 | $199.53 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $446.68
| Professional | 26 | $40.74 | $58.88 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $141.25 / $870.96
| Professional | TC | $83.18 | $141.25 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $165.96 / $269.15
| Professional | | $120.23 | $165.96 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $50.12 / $83.18
| Professional | 26 | $38.90 | $50.12 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $112.20 / $190.55
| Professional | TC | $81.28 | $112.20 | $190.55 |