- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $89.13 / $120.23
| Facility | 26 | $81.28 | $89.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $416.87 / $977.24
| Professional | | $257.04 | $416.87 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $125.89 / $316.23
| Professional | 26 | $81.28 | $125.89 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $281.84 / $537.03
| Professional | TC | $186.21 | $281.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $102.33
| Professional | 26 | $79.43 | $89.13 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $371.54 / $741.31
| Professional | | $331.13 | $371.54 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $100.00 / $169.82
| Professional | 26 | $91.20 | $100.00 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $257.04 / $602.56
| Professional | TC | $234.42 | $257.04 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $107.15 / $125.89
| Professional | | $72.44 | $107.15 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $97.72 / $138.04
| Facility | 26 | $20.89 | $97.72 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $630.96 / $2,630.27
| Professional | | $309.03 | $630.96 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $141.25 / $426.58
| Professional | 26 | $77.62 | $141.25 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $524.81 / $1,778.28
| Professional | TC | $213.80 | $524.81 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $380.19
| Professional | | $32.36 | $33.11 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $524.81 / $724.44
| Professional | | $269.15 | $524.81 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $91.20 / $154.88
| Professional | 26 | $79.43 | $91.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $416.87 / $588.84
| Professional | TC | $190.55 | $416.87 | $588.84 |