- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $131.83 / $177.83
| Facility | 26 | $54.95 | $131.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $346.74 / $1,380.38
| Professional | | $239.88 | $346.74 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $57.54 / $134.90
| Professional | 26 | $30.90 | $57.54 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $288.40 / $831.76
| Professional | TC | $208.93 | $288.40 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $2,511.89
| Professional | | $346.74 | $346.74 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $269.15
| Professional | 26 | $36.31 | $36.31 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $2,238.72
| Professional | TC | $309.03 | $309.03 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $323.59 / $575.44
| Professional | | $251.19 | $323.59 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $44.67 / $70.79
| Professional | 26 | $30.90 | $44.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $281.84 / $549.54
| Professional | TC | $213.80 | $281.84 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $169.82 / $169.82
| Facility | 26 | $87.10 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $295.12 / $2,041.74
| Professional | | $218.78 | $295.12 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $38.02 / $269.15
| Professional | 26 | $31.62 | $38.02 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $263.03 / $1,778.28
| Professional | TC | $186.21 | $263.03 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $295.12 / $549.54
| Professional | | $218.78 | $295.12 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $33.88 / $70.79
| Professional | 26 | $31.62 | $33.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $257.04 / $489.78
| Professional | TC | $186.21 | $257.04 | $489.78 |