- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $85.11 / $85.11
| Facility | 26 | $79.43 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $398.11 / $891.25
| Professional | | $257.04 | $398.11 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $194.98
| Professional | 26 | $79.43 | $112.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $275.42 / $467.74
| Professional | TC | $186.21 | $275.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $436.52 / $794.33
| Professional | | $363.08 | $436.52 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $95.50 / $141.25
| Professional | 26 | $79.43 | $95.50 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $338.84 / $645.65
| Professional | TC | $275.42 | $338.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $125.89
| Professional | | $75.86 | $107.15 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $93.33 / $131.83
| Facility | 26 | $19.95 | $93.33 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $660.69 / $2,570.40
| Professional | | $316.23 | $660.69 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $134.90 / $407.38
| Professional | 26 | $75.86 | $134.90 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $524.81 / $1,737.80
| Professional | TC | $218.78 | $524.81 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $316.23
| Professional | | $32.36 | $33.11 | $316.23 |
- 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
- $77.62 / $89.13 / $147.91
| Professional | 26 | $77.62 | $89.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $416.87 / $588.84
| Professional | TC | $190.55 | $416.87 | $588.84 |