- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $371.54 / $501.19
| Facility | 26 | $165.96 | $371.54 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $213.80 / $794.33
| Professional | | $114.82 | $213.80 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $162.18 / $478.63
| Professional | 26 | $89.13 | $162.18 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $54.95 / $169.82
| Professional | TC | $21.88 | $54.95 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $154.88 / $1,096.48
| Professional | | $151.36 | $154.88 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $114.82 / $812.83
| Professional | 26 | $112.20 | $114.82 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $41.69 / $295.12
| Professional | TC | $40.74 | $41.69 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $223.87 / $436.52
| Professional | | $138.04 | $223.87 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $125.89 / $194.98
| Professional | 26 | $93.33 | $125.89 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $46.77 / $302.00
| Professional | TC | $28.18 | $46.77 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $251.19 / $724.44 / $724.44
| Facility | 26 | $251.19 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $295.12 / $3,019.95
| Professional | | $165.96 | $295.12 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $138.04 / $1,047.13
| Professional | 26 | $114.82 | $138.04 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $89.13 / $2,511.89
| Professional | TC | $30.90 | $89.13 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $208.93 / $446.68
| Professional | | $151.36 | $208.93 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $131.83 / $190.55
| Professional | 26 | $112.20 | $131.83 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $57.54 / $323.59
| Professional | TC | $30.90 | $57.54 | $323.59 |