- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $204.17 / $275.42
| Facility | 26 | $109.65 | $204.17 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $426.58 / $1,288.25
| Professional | | $218.78 | $426.58 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $117.49 / $234.42
| Professional | 26 | $57.54 | $117.49 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $288.40 / $602.56
| Professional | TC | $162.18 | $288.40 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $165.96 / $181.97
| Professional | | $144.54 | $165.96 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $45.71 / $79.43
| Professional | 26 | $41.69 | $45.71 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $316.23 / $501.19
| Professional | | $251.19 | $316.23 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $70.79 / $112.20
| Professional | 26 | $56.23 | $70.79 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $389.05
| Professional | TC | $194.98 | $245.47 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $64.57 / $91.20
| Facility | 26 | $13.80 | $64.57 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $426.58 / $776.25
| Professional | | $181.97 | $426.58 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $66.07 / $125.89
| Professional | 26 | $43.65 | $66.07 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $323.59 / $630.96
| Professional | TC | $138.04 | $323.59 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $524.81 / $524.81
| Facility | 26 | $407.38 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $501.19 / $2,951.21
| Professional | | $213.80 | $501.19 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $64.57 / $501.19
| Professional | 26 | $48.98 | $64.57 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $416.87 / $2,630.27
| Professional | TC | $158.49 | $416.87 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $354.81 / $707.95
| Professional | | $194.98 | $354.81 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $61.66 / $138.04
| Professional | 26 | $48.98 | $61.66 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $295.12 / $602.56
| Professional | TC | $151.36 | $295.12 | $602.56 |