- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $123.03 / $123.03
| Facility | 26 | $79.43 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $389.05 / $891.25
| Professional | | $234.42 | $389.05 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $91.20 / $275.42
| Professional | 26 | $75.86 | $91.20 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $229.09 / $457.09
| Professional | TC | $147.91 | $229.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $251.19 / $398.11
| Professional | | $199.53 | $251.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $83.18 / $109.65
| Professional | 26 | $63.10 | $83.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | TC | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $446.68 / $537.03
| Professional | | $165.96 | $446.68 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $134.90 / $173.78
| Professional | 26 | $95.50 | $134.90 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $316.23 / $371.54
| Professional | TC | $114.82 | $316.23 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $436.52 / $851.14
| Professional | | $269.15 | $436.52 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $109.65 / $223.87
| Professional | 26 | $72.44 | $109.65 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $309.03 / $602.56
| Professional | TC | $177.83 | $309.03 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $691.83
| Professional | | $218.78 | $338.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $93.33 / $181.97
| Professional | 26 | $70.79 | $93.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $229.09 / $549.54
| Professional | TC | $158.49 | $229.09 | $549.54 |