- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $141.25 / $354.81
| Facility | 26 | $48.98 | $141.25 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $169.82 / $407.38
| Professional | | $97.72 | $169.82 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $107.15 / $190.55
| Professional | 26 | $53.70 | $107.15 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $407.38
| Professional | TC | $112.20 | $173.78 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $239.88 / $1,122.02
| Professional | | $151.36 | $239.88 | $1,122.02 |
- 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
- $147.91 / $165.96 / $165.96
| Professional | TC | $147.91 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $316.23 / $645.65
| Professional | | $190.55 | $316.23 | $645.65 |
- 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
- $141.25 / $245.47 / $512.86
| Professional | TC | $141.25 | $245.47 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $190.55 / $467.74
| Professional | | $162.18 | $190.55 | $467.74 |
- 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
- $112.20 / $131.83 / $354.81
| Professional | TC | $112.20 | $131.83 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $190.55 / $1,096.48
| Professional | | $95.50 | $190.55 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $181.97 / $346.74
| Professional | 26 | $51.29 | $181.97 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $199.53 / $758.58
| Professional | TC | $117.49 | $199.53 | $758.58 |