- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $77.62 / $141.25
| Facility | 26 | $43.65 | $77.62 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $229.09 / $933.25
| Professional | | $177.83 | $229.09 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $223.87
| Professional | 26 | $38.90 | $61.66 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $177.83 / $562.34
| Professional | TC | $138.04 | $177.83 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $263.03 / $446.68
| Professional | | $208.93 | $263.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $58.88 / $97.72
| Professional | 26 | $47.86 | $58.88 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $204.17 / $346.74
| Professional | TC | $162.18 | $204.17 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $245.47 / $338.84
| Professional | | $218.78 | $245.47 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $50.12 / $75.86
| Professional | 26 | $48.98 | $50.12 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $190.55 / $263.03
| Professional | TC | $169.82 | $190.55 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $457.09
| Professional | | $186.21 | $309.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $64.57 / $100.00
| Professional | 26 | $41.69 | $64.57 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $239.88 / $363.08
| Professional | TC | $141.25 | $239.88 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $208.93 / $208.93
| Facility | 26 | $107.15 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $302.00 / $1,479.11
| Professional | | $199.53 | $302.00 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $501.19
| Professional | 26 | $41.69 | $61.66 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $245.47 / $1,230.27
| Professional | TC | $158.49 | $245.47 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $275.42 / $436.52
| Professional | | $199.53 | $275.42 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $57.54 / $95.50
| Professional | 26 | $43.65 | $57.54 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $218.78 / $346.74
| Professional | TC | $154.88 | $218.78 | $346.74 |