- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $39.81 / $64.57
| Facility | 26 | $38.90 | $39.81 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $223.87 / $478.63
| Professional | | $173.78 | $223.87 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $89.13
| Professional | 26 | $34.67 | $41.69 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $173.78 / $416.87
| Professional | TC | $134.90 | $173.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $436.52 / $478.63
| Professional | | $331.13 | $436.52 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $87.10 / $95.50
| Professional | 26 | $64.57 | $87.10 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $346.74 / $389.05
| Professional | TC | $263.03 | $346.74 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $354.81 / $524.81
| Professional | | $208.93 | $354.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $67.61 / $100.00
| Professional | 26 | $36.31 | $67.61 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $288.40 / $426.58
| Professional | TC | $165.96 | $288.40 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $380.19 / $1,584.89
| Professional | | $204.17 | $380.19 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $74.13 / $426.58
| Professional | 26 | $40.74 | $74.13 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $309.03 / $1,412.54
| Professional | TC | $181.97 | $309.03 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $331.13 / $489.78
| Professional | | $114.82 | $331.13 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $70.79 / $102.33
| Professional | 26 | $36.31 | $70.79 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $288.40 / $407.38
| Professional | TC | $162.18 | $288.40 | $407.38 |