- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $95.50 / $165.96
| Facility | 26 | $79.43 | $95.50 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $398.11 / $954.99
| Professional | | $213.80 | $398.11 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $125.89 / $218.78
| Professional | 26 | $69.18 | $125.89 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $263.03 / $501.19
| Professional | TC | $144.54 | $263.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $288.40 / $724.44
| Professional | | $194.98 | $288.40 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $100.00 / $223.87
| Professional | 26 | $66.07 | $100.00 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $186.21 / $478.63
| Professional | TC | $125.89 | $186.21 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $549.54 / $912.01
| Professional | | $269.15 | $549.54 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $102.33 / $204.17
| Professional | 26 | $70.79 | $102.33 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $407.38 / $691.83
| Professional | TC | $177.83 | $407.38 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $295.12 / $549.54
| Professional | | $234.42 | $295.12 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $100.00 / $190.55
| Professional | 26 | $79.43 | $100.00 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $363.08
| Professional | TC | $154.88 | $194.98 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $165.96 / $9,332.54
| Facility | 26 | $79.43 | $165.96 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $426.58 / $891.25
| Professional | | $251.19 | $426.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $218.78
| Professional | 26 | $83.18 | $120.23 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $281.84 / $616.60
| Professional | TC | $162.18 | $281.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $371.54 / $758.58
| Professional | | $194.98 | $371.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $281.84
| Professional | 26 | $75.86 | $104.71 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $257.04 / $537.03
| Professional | TC | $154.88 | $257.04 | $537.03 |