- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $87.10 / $147.91
| Facility | 26 | $64.57 | $87.10 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $389.05 / $933.25
| Professional | | $234.42 | $389.05 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $91.20 / $239.88
| Professional | 26 | $77.62 | $91.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $257.04 / $691.83
| Professional | TC | $158.49 | $257.04 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $660.69 / $741.31
| Professional | | $501.19 | $660.69 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $199.53 / $218.78
| Professional | 26 | $151.36 | $199.53 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $467.74 / $512.86
| Professional | TC | $346.74 | $467.74 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $549.54 / $851.14
| Professional | | $354.81 | $549.54 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $131.83 / $223.87
| Professional | 26 | $91.20 | $131.83 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $389.05 / $630.96
| Professional | TC | $245.47 | $389.05 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Facility | 26 | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $549.54 / $3,162.28
| Professional | | $309.03 | $549.54 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $181.97 / $446.68
| Professional | 26 | $109.65 | $181.97 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $398.11 / $2,691.53
| Professional | TC | $213.80 | $398.11 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $501.19 / $758.58
| Professional | | $100.00 | $501.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $147.91 / $229.09
| Professional | 26 | $93.33 | $147.91 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $398.11 / $575.44
| Professional | TC | $213.80 | $398.11 | $575.44 |