- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $57.54 / $58.88
| Facility | 26 | $34.67 | $57.54 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $169.82 / $295.12
| Professional | | $128.82 | $169.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $48.98 / $112.20
| Professional | 26 | $34.67 | $48.98 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $123.03 / $199.53
| Professional | TC | $93.33 | $123.03 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $177.83 / $229.09
| Professional | | $107.15 | $177.83 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $41.69 / $47.86
| Professional | 26 | $28.18 | $41.69 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $151.36 / $208.93
| Professional | | $38.02 | $151.36 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $89.13
| Facility | 26 | $75.86 | $75.86 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $234.42 / $288.40
| Professional | | $162.18 | $234.42 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $87.10
| Professional | 26 | $40.74 | $63.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $165.96 / $208.93
| Professional | TC | $120.23 | $165.96 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $251.19 / $251.19
| Facility | 26 | $89.13 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $208.93 / $1,348.96
| Professional | | $144.54 | $208.93 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $60.26 / $338.84
| Professional | 26 | $34.67 | $60.26 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $158.49 / $1,023.29
| Professional | TC | $107.15 | $158.49 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $177.83 / $302.00
| Professional | | $128.82 | $177.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $45.71 / $83.18
| Professional | 26 | $33.11 | $45.71 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $128.82 / $229.09
| Professional | TC | $97.72 | $128.82 | $229.09 |