- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $229.09 / $263.03
| Facility | 26 | $114.82 | $229.09 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $616.60
| Professional | | $204.17 | $281.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $58.88 / $144.54
| Professional | 26 | $41.69 | $58.88 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $234.42 / $501.19
| Professional | TC | $169.82 | $234.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $467.74 / $676.08
| Professional | | $223.87 | $467.74 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $64.57 / $97.72
| Professional | 26 | $38.02 | $64.57 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $389.05 / $588.84
| Professional | TC | $186.21 | $389.05 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $457.09 / $870.96
| Professional | | $281.84 | $457.09 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $72.44 / $138.04
| Professional | 26 | $48.98 | $72.44 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $371.54 / $776.25
| Professional | TC | $218.78 | $371.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $457.09 / $549.54
| Professional | | $416.87 | $457.09 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $69.18 / $89.13
| Professional | 26 | $54.95 | $69.18 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $389.05 / $467.74
| Professional | TC | $346.74 | $389.05 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $389.05 / $741.31
| Professional | | $257.04 | $389.05 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $66.07 / $128.82
| Professional | 26 | $42.66 | $66.07 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $331.13 / $630.96
| Professional | TC | $208.93 | $331.13 | $630.96 |