- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $177.83
| Facility | 26 | $128.82 | $162.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $363.08 / $562.34
| Professional | | $263.03 | $363.08 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $147.91 / $331.13
| Professional | 26 | $70.79 | $147.91 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $218.78 / $407.38
| Professional | TC | $158.49 | $218.78 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $85.11 / $141.25
| Professional | 26 | $83.18 | $85.11 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $407.38 / $562.34
| Professional | | $112.20 | $407.38 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $177.83
| Facility | 26 | $112.20 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $478.63 / $794.33
| Professional | | $346.74 | $478.63 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $117.49 / $186.21
| Professional | 26 | $95.50 | $117.49 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $363.08 / $602.56
| Professional | TC | $245.47 | $363.08 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $812.83 / $1,047.13 / $1,047.13
| Facility | 26 | $812.83 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $537.03 / $4,786.30
| Professional | | $363.08 | $537.03 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $128.82 / $1,621.81
| Professional | 26 | $100.00 | $128.82 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $446.68 / $3,630.78
| Professional | TC | $263.03 | $446.68 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $446.68 / $776.25
| Professional | | $346.74 | $446.68 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $120.23 / $229.09
| Professional | 26 | $97.72 | $120.23 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $331.13 / $602.56
| Professional | TC | $245.47 | $331.13 | $602.56 |