- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $109.65 / $120.23
| Facility | 26 | $81.28 | $109.65 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $426.58 / $977.24
| Professional | | $134.90 | $426.58 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $112.20 / $263.03
| Professional | 26 | $64.57 | $112.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $575.44
| Professional | TC | $218.78 | $338.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $269.15
| Professional | | $204.17 | $204.17 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $58.88 / $61.66
| Professional | 26 | $43.65 | $58.88 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $457.09 / $549.54
| Professional | | $371.54 | $457.09 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $89.13 / $114.82
| Professional | 26 | $74.13 | $89.13 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $354.81 / $436.52
| Professional | TC | $302.00 | $354.81 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $63.10 / $63.10
| Professional | 26 | $60.26 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $371.54 / $741.31
| Professional | | $213.80 | $371.54 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $75.86 / $141.25
| Professional | 26 | $45.71 | $75.86 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $295.12 / $602.56
| Professional | TC | $169.82 | $295.12 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $398.11 / $676.08
| Professional | | $269.15 | $398.11 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $69.18 / $104.71
| Professional | 26 | $53.70 | $69.18 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $309.03 / $562.34
| Professional | TC | $213.80 | $309.03 | $562.34 |