- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $91.20 / $97.72
| Facility | 26 | $64.57 | $91.20 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $134.90 / $380.19
| Professional | | $95.50 | $134.90 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $107.15 / $891.25
| Professional | 26 | $52.48 | $107.15 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $69.18 / $154.88
| Professional | TC | $46.77 | $69.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $144.54 / $186.21
| Professional | | $125.89 | $144.54 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $70.79 / $91.20
| Professional | 26 | $61.66 | $70.79 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $72.44 / $93.33
| Professional | TC | $63.10 | $72.44 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $134.90 / $269.15
| Professional | | $131.83 | $134.90 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $208.93 / $302.00
| Professional | | $123.03 | $208.93 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $125.89
| Professional | 26 | $57.54 | $91.20 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $107.15 / $151.36
| Professional | TC | $63.10 | $107.15 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $257.04
| Professional | | $223.87 | $223.87 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $112.20 / $128.82
| Professional | 26 | $89.13 | $112.20 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Professional | TC | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $177.83 / $281.84
| Professional | | $117.49 | $177.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $70.79 / $117.49
| Professional | 26 | $56.23 | $70.79 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $100.00 / $158.49
| Professional | TC | $58.88 | $100.00 | $158.49 |