- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $213.80 / $234.42
| Facility | 26 | $169.82 | $213.80 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $114.82 / $407.38
| Professional | | $70.79 | $114.82 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $60.26 / $218.78
| Professional | 26 | $40.74 | $60.26 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $57.54 / $134.90
| Professional | TC | $33.11 | $57.54 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $102.33 / $724.44
| Professional | | $100.00 | $102.33 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $53.70 / $380.19
| Professional | 26 | $52.48 | $53.70 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $47.86 / $338.84
| Professional | TC | $46.77 | $47.86 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $138.04 / $204.17
| Professional | | $91.20 | $138.04 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $57.54 / $89.13
| Professional | 26 | $42.66 | $57.54 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $64.57 / $131.83
| Professional | TC | $40.74 | $64.57 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $263.03 / $263.03
| Facility | 26 | $117.49 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $154.88 / $1,148.15
| Professional | | $114.82 | $154.88 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $489.78
| Professional | 26 | $52.48 | $63.10 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $83.18 / $891.25
| Professional | TC | $53.70 | $83.18 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $123.03 / $190.55
| Professional | | $100.00 | $123.03 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $61.66 / $87.10
| Professional | 26 | $52.48 | $61.66 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $64.57 / $134.90
| Professional | TC | $46.77 | $64.57 | $134.90 |