- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $52.48 / $83.18
| Facility | 26 | $50.12 | $52.48 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $338.84
| Professional | | $109.65 | $154.88 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $54.95 / $125.89
| Professional | 26 | $31.62 | $54.95 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $107.15 / $204.17
| Professional | TC | $79.43 | $107.15 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $346.74 / $389.05
| Professional | | $263.03 | $346.74 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $112.20 / $123.03
| Professional | 26 | $85.11 | $112.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $239.88 / $263.03
| Professional | TC | $177.83 | $239.88 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $234.42 / $389.05
| Professional | | $120.23 | $234.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $72.44 / $112.20
| Professional | 26 | $37.15 | $72.44 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $162.18 / $275.42
| Professional | TC | $85.11 | $162.18 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $281.84 / $1,023.29
| Professional | | $147.91 | $281.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $69.18 / $309.03
| Professional | 26 | $41.69 | $69.18 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $199.53 / $707.95
| Professional | TC | $97.72 | $199.53 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $257.04 / $380.19
| Professional | | $100.00 | $257.04 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $85.11 / $131.83
| Professional | 26 | $38.02 | $85.11 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $186.21 / $269.15
| Professional | TC | $97.72 | $186.21 | $269.15 |