- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $47.86 / $47.86
| Facility | 26 | $46.77 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $134.90 / $281.84
| Professional | | $112.20 | $134.90 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $109.65
| Professional | 26 | $39.81 | $46.77 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $85.11 / $144.54
| Professional | TC | $70.79 | $85.11 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $251.19
| Professional | | $109.65 | $154.88 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $53.70 / $87.10
| Professional | 26 | $38.90 | $53.70 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $102.33 / $162.18
| Professional | TC | $70.79 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $190.55 / $275.42
| Professional | | $125.89 | $190.55 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $64.57 / $95.50
| Professional | 26 | $46.77 | $64.57 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $123.03 / $190.55
| Professional | TC | $77.62 | $123.03 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $199.53 / $251.19
| Professional | | $128.82 | $199.53 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $69.18 / $107.15
| Professional | 26 | $44.67 | $69.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $131.83 / $147.91
| Professional | TC | $83.18 | $131.83 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $128.82 / $190.55
| Professional | | $117.49 | $128.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $44.67 / $72.44
| Professional | 26 | $42.66 | $44.67 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $83.18 / $120.23
| Professional | TC | $74.13 | $83.18 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $181.97 / $295.12
| Professional | | $131.83 | $181.97 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $72.44 / $117.49
| Professional | 26 | $50.12 | $72.44 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $104.71 / $208.93
| Professional | TC | $81.28 | $104.71 | $208.93 |