- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $114.82 / $316.23
| Facility | 26 | $72.44 | $114.82 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $478.63 / $1,380.38
| Professional | | $245.47 | $478.63 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $125.89 / $269.15
| Professional | 26 | $67.61 | $125.89 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $147.91 / $549.54 / $1,995.26
| Professional | 52 | $147.91 | $549.54 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $302.00 / $602.56
| Professional | TC | $169.82 | $302.00 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Facility | 26 | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $407.38 / $831.76
| Professional | | $234.42 | $407.38 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $83.18 / $165.96
| Professional | 26 | $64.57 | $83.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $316.23 / $707.95
| Professional | TC | $177.83 | $316.23 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $89.13 / $239.88
| Facility | 26 | $16.98 | $89.13 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $467.74 / $870.96
| Professional | | $234.42 | $467.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $97.72 / $190.55
| Professional | 26 | $56.23 | $97.72 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $346.74 / $707.95
| Professional | TC | $165.96 | $346.74 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $380.19 / $912.01
| Professional | | $208.93 | $380.19 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $346.74
| Professional | 26 | $60.26 | $89.13 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $281.84 / $645.65
| Professional | TC | $165.96 | $281.84 | $645.65 |