- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $93.33
| Facility | 26 | $39.81 | $56.23 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $251.19 / $446.68
| Professional | | $147.91 | $251.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $147.91
| Professional | 26 | $45.71 | $70.79 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $204.17 / $363.08
| Professional | TC | $131.83 | $204.17 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $467.74 / $524.81
| Professional | | $354.81 | $467.74 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $125.89 / $141.25
| Professional | 26 | $95.50 | $125.89 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $346.74 / $380.19
| Professional | TC | $257.04 | $346.74 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $389.05 / $549.54
| Professional | | $251.19 | $389.05 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $83.18 / $141.25
| Professional | 26 | $56.23 | $83.18 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $281.84 / $407.38
| Professional | TC | $186.21 | $281.84 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Facility | 26 | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $416.87 / $1,621.81
| Professional | | $223.87 | $416.87 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $107.15 / $346.74
| Professional | 26 | $57.54 | $107.15 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $302.00 / $1,318.26
| Professional | TC | $165.96 | $302.00 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $354.81 / $537.03
| Professional | | $100.00 | $354.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $100.00 / $147.91
| Professional | 26 | $57.54 | $100.00 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $288.40 / $426.58
| Professional | TC | $165.96 | $288.40 | $426.58 |