- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $162.18 / $354.81
| Facility | 26 | $48.98 | $162.18 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $562.34
| Professional | | $208.93 | $275.42 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $93.33 / $177.83
| Professional | 26 | $52.48 | $93.33 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $213.80 / $426.58
| Professional | TC | $158.49 | $213.80 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $331.13 / $1,288.25
| Professional | | $239.88 | $331.13 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $64.57 / $70.79
| Professional | 26 | $63.10 | $64.57 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $234.42 / $257.04
| Professional | TC | $204.17 | $234.42 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $346.74 / $691.83
| Professional | | $213.80 | $346.74 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $66.07 / $154.88
| Professional | 26 | $43.65 | $66.07 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $275.42 / $549.54
| Professional | TC | $165.96 | $275.42 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $263.03 / $562.34
| Professional | | $223.87 | $263.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $57.54 / $120.23
| Professional | 26 | $48.98 | $57.54 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $204.17 / $436.52
| Professional | TC | $173.78 | $204.17 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $275.42 / $1,698.24
| Professional | | $95.50 | $275.42 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $95.50 / $346.74
| Professional | 26 | $51.29 | $95.50 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $269.15 / $1,096.48
| Professional | TC | $158.49 | $269.15 | $1,096.48 |