- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $275.42 / $380.19
| Facility | 26 | $52.48 | $275.42 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $275.42 / $676.08
| Professional | | $204.17 | $275.42 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $158.49
| Professional | 26 | $53.70 | $72.44 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $199.53 / $407.38
| Professional | TC | $147.91 | $199.53 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $269.15 / $1,288.25
| Professional | | $77.62 | $269.15 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $70.79 / $75.86
| Professional | 26 | $67.61 | $70.79 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $275.42
| Professional | TC | $199.53 | $199.53 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $398.11 / $870.96
| Professional | | $251.19 | $398.11 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $81.28 / $169.82
| Professional | 26 | $50.12 | $81.28 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $316.23 / $724.44
| Professional | TC | $199.53 | $316.23 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $239.88 / $630.96
| Professional | | $204.17 | $239.88 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $63.10 / $141.25
| Professional | 26 | $53.70 | $63.10 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $177.83 / $489.78
| Professional | TC | $151.36 | $177.83 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $363.08 / $1,412.54
| Professional | | $208.93 | $363.08 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $194.98 / $426.58
| Professional | 26 | $57.54 | $194.98 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $275.42 / $954.99
| Professional | TC | $158.49 | $275.42 | $954.99 |