- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $89.13 / $138.04
| Facility | 26 | $87.10 | $89.13 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $380.19 / $645.65
| Professional | | $275.42 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $151.36 / $281.84
| Professional | 26 | $89.13 | $151.36 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $263.03 / $426.58
| Professional | TC | $190.55 | $263.03 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $138.04
| Professional | 26 | $81.28 | $81.28 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $354.81 / $489.78
| Professional | | $109.65 | $354.81 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Facility | 26 | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $371.54 / $588.84
| Professional | | $295.12 | $371.54 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $112.20 / $181.97
| Professional | 26 | $89.13 | $112.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $251.19 / $416.87
| Professional | TC | $199.53 | $251.19 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $794.33 / $1,023.29 / $1,023.29
| Facility | 26 | $794.33 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $467.74 / $2,344.23
| Professional | | $346.74 | $467.74 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $691.83
| Professional | 26 | $74.13 | $117.49 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $407.38 / $1,659.59
| Professional | TC | $251.19 | $407.38 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $446.68 / $1,047.13
| Professional | | $338.84 | $446.68 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $109.65 / $218.78
| Professional | 26 | $69.18 | $109.65 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $316.23 / $954.99
| Professional | TC | $239.88 | $316.23 | $954.99 |