- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $81.28 / $223.87
| Facility | 26 | $30.20 | $81.28 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $281.84 / $467.74
| Professional | | $223.87 | $281.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $46.77 / $95.50
| Professional | 26 | $26.92 | $46.77 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $251.19 / $416.87
| Professional | TC | $204.17 | $251.19 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $676.08 / $1,412.54
| Professional | | $331.13 | $676.08 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Professional | 26 | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Professional | TC | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $524.81 / $1,513.56
| Professional | | $263.03 | $524.81 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $51.29 / $154.88
| Professional | 26 | $28.84 | $51.29 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $478.63 / $1,380.38
| Professional | TC | $234.42 | $478.63 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $363.08 / $707.95
| Professional | | $316.23 | $363.08 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $40.74 / $75.86
| Professional | 26 | $34.67 | $40.74 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $323.59 / $645.65
| Professional | TC | $281.84 | $323.59 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $489.78 / $1,071.52
| Professional | | $295.12 | $489.78 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $48.98 / $114.82
| Professional | 26 | $28.18 | $48.98 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $446.68 / $954.99
| Professional | TC | $263.03 | $446.68 | $954.99 |