- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $213.80 / $257.04
| Facility | 26 | $95.50 | $213.80 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $190.55 / $524.81
| Professional | | $83.18 | $190.55 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $91.20 / $229.09
| Professional | 26 | $52.48 | $91.20 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $186.21 / $398.11
| Professional | TC | $114.82 | $186.21 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $380.19 / $724.44
| Professional | | $177.83 | $380.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $102.33 / $147.91
| Professional | 26 | $53.70 | $102.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $257.04 / $562.34
| Professional | TC | $123.03 | $257.04 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $371.54 / $602.56
| Professional | | $245.47 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $162.18
| Professional | 26 | $60.26 | $81.28 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $295.12 / $457.09
| Professional | TC | $169.82 | $295.12 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $354.81 / $457.09
| Professional | | $239.88 | $354.81 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $72.44 / $87.10
| Professional | 26 | $60.26 | $72.44 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $323.59
| Professional | TC | $154.88 | $194.98 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $95.50 / $141.25
| Professional | | $77.62 | $95.50 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $257.04 / $602.56
| Professional | | $165.96 | $257.04 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $158.49
| Professional | 26 | $48.98 | $70.79 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $177.83 / $416.87
| Professional | TC | $117.49 | $177.83 | $416.87 |