- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $251.19 / $354.81
| Facility | 26 | $51.29 | $251.19 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $346.74 / $794.33
| Professional | | $245.47 | $346.74 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $93.33 / $263.03
| Professional | 26 | $51.29 | $93.33 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $234.42 / $371.54
| Professional | TC | $181.97 | $234.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $281.84 / $1,479.11
| Professional | | $239.88 | $281.84 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $57.54 / $60.26
| Professional | 26 | $51.29 | $57.54 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $257.04
| Professional | TC | $213.80 | $213.80 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $389.05 / $831.76
| Professional | | $263.03 | $389.05 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $87.10 / $169.82
| Professional | 26 | $51.29 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $295.12 / $588.84
| Professional | TC | $208.93 | $295.12 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $302.00 / $630.96
| Professional | | $257.04 | $302.00 | $630.96 |
- 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
- $204.17 / $245.47 / $512.86
| Professional | TC | $204.17 | $245.47 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $346.74 / $1,202.26
| Professional | | $95.50 | $346.74 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $95.50 / $281.84
| Professional | 26 | $52.48 | $95.50 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $309.03 / $912.01
| Professional | TC | $95.50 | $309.03 | $912.01 |