- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $102.33 / $134.90
| Facility | 26 | $75.86 | $102.33 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $478.63 / $794.33
| Professional | | $398.11 | $478.63 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $204.17
| Professional | 26 | $72.44 | $93.33 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $389.05 / $660.69
| Professional | TC | $316.23 | $389.05 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Professional | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $109.65
| Professional | 26 | $63.10 | $91.20 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $446.68 / $676.08
| Professional | | $389.05 | $446.68 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $87.10 / $162.18
| Professional | 26 | $81.28 | $87.10 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $346.74 / $524.81
| Professional | TC | $302.00 | $346.74 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $338.84 / $537.03
| Professional | | $85.11 | $338.84 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $93.33 / $134.90
| Facility | 26 | $19.95 | $93.33 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $724.44 / $2,041.74
| Professional | | $416.87 | $724.44 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $134.90 / $389.05
| Professional | 26 | $77.62 | $134.90 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $630.96 / $1,659.59
| Professional | TC | $323.59 | $630.96 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $436.52
| Professional | | $32.36 | $33.11 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $501.19 / $758.58
| Professional | | $371.54 | $501.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $85.11 / $131.83
| Professional | 26 | $70.79 | $85.11 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $660.69
| Professional | TC | $302.00 | $416.87 | $660.69 |