- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $87.10
| Facility | 26 | $52.48 | $63.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $398.11 / $851.14
| Professional | | $323.59 | $398.11 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $69.18 / $158.49
| Professional | 26 | $51.29 | $69.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $323.59 / $588.84
| Professional | TC | $251.19 | $323.59 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $380.19 / $575.44
| Professional | | $354.81 | $380.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $70.79 / $95.50
| Professional | 26 | $50.12 | $70.79 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $389.05 / $562.34
| Professional | | $213.80 | $389.05 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $75.86 / $117.49
| Professional | 26 | $48.98 | $75.86 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $134.90 / $309.03
| Professional | TC | $109.65 | $134.90 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $346.74 / $467.74
| Professional | | $57.54 | $346.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $380.19 / $691.83
| Professional | | $177.83 | $380.19 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $69.18 / $117.49
| Professional | 26 | $52.48 | $69.18 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $323.59 / $602.56
| Professional | TC | $117.49 | $323.59 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $354.81 / $645.65
| Professional | | $223.87 | $354.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $61.66 / $104.71
| Professional | 26 | $48.98 | $61.66 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $295.12 / $524.81
| Professional | TC | $169.82 | $295.12 | $524.81 |