- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $125.89
| Facility | 26 | $52.48 | $63.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $134.90 / $263.03
| Professional | | $85.11 | $134.90 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $125.89
| Professional | 26 | $40.74 | $58.88 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $44.67 / $79.43 / $120.23
| Professional | 52 | $44.67 | $79.43 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $77.62 / $162.18
| Professional | TC | $43.65 | $77.62 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $87.10
| Professional | | $83.18 | $83.18 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $66.07
| Professional | 26 | $37.15 | $50.12 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $112.20 / $190.55
| Professional | | $95.50 | $112.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $52.48 / $72.44
| Professional | 26 | $44.67 | $52.48 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $58.88 / $117.49
| Professional | TC | $50.12 | $58.88 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $61.66 / $61.66
| Professional | 26 | $39.81 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $134.90 / $275.42
| Professional | | $89.13 | $134.90 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $58.88 / $104.71
| Professional | 26 | $41.69 | $58.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $72.44 / $165.96
| Professional | TC | $46.77 | $72.44 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $158.49 / $257.04
| Professional | | $102.33 | $158.49 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $60.26 / $95.50
| Professional | 26 | $39.81 | $60.26 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $93.33 / $154.88
| Professional | TC | $60.26 | $93.33 | $154.88 |