- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $72.44 / $117.49
| Facility | 26 | $70.79 | $72.44 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $436.52 / $741.31
| Professional | | $288.40 | $436.52 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $120.23 / $181.97
| Professional | 26 | $69.18 | $120.23 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $323.59 / $562.34
| Professional | TC | $218.78 | $323.59 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $776.25 / $870.96
| Professional | | $588.84 | $776.25 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $158.49 / $177.83
| Professional | 26 | $120.23 | $158.49 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $478.63 / $630.96 / $691.83
| Professional | TC | $478.63 | $630.96 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $660.69 / $912.01
| Professional | | $436.52 | $660.69 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $112.20 / $177.83
| Professional | 26 | $70.79 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $501.19 / $741.31
| Professional | TC | $346.74 | $501.19 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | 26 | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $758.58 / $3,090.30
| Professional | | $407.38 | $758.58 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $134.90 / $676.08
| Professional | 26 | $72.44 | $134.90 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $616.60 / $2,691.53
| Professional | TC | $331.13 | $616.60 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $588.84 / $954.99
| Professional | | $100.00 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $117.49 / $181.97
| Professional | 26 | $72.44 | $117.49 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $562.34 / $794.33
| Professional | TC | $331.13 | $562.34 | $794.33 |