- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $33.88 / $38.02
| Facility | 26 | $30.20 | $33.88 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $138.04 / $269.15
| Professional | | $51.29 | $138.04 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $52.48
| Professional | 26 | $20.89 | $26.92 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $112.20 / $213.80
| Professional | TC | $91.20 | $112.20 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $16.98 / $24.55
| Professional | 26 | $16.60 | $16.98 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Professional | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $169.82 / $288.40
| Professional | | $109.65 | $169.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $28.84 / $45.71
| Professional | 26 | $19.95 | $28.84 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $154.88 / $275.42
| Professional | TC | $97.72 | $154.88 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $102.33
| Facility | 26 | $53.70 | $53.70 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $199.53 / $1,023.29
| Professional | | $128.82 | $199.53 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $30.90 / $204.17
| Professional | 26 | $19.05 | $30.90 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $181.97 / $933.25
| Professional | TC | $104.71 | $181.97 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $165.96 / $245.47
| Professional | | $131.83 | $165.96 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $25.12 / $44.67
| Professional | 26 | $18.62 | $25.12 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $138.04 / $213.80
| Professional | TC | $107.15 | $138.04 | $213.80 |