- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $89.13 / $117.49
| Facility | 26 | $42.66 | $89.13 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $478.63
| Professional | | $208.93 | $275.42 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $53.70 / $147.91
| Professional | 26 | $41.69 | $53.70 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $229.09 / $338.84
| Professional | TC | $169.82 | $229.09 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $69.18 / $81.28
| Professional | 26 | $47.86 | $69.18 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $316.23 / $575.44
| Professional | | $257.04 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $64.57 / $100.00
| Professional | 26 | $45.71 | $64.57 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $316.23 / $501.19
| Professional | TC | $208.93 | $316.23 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $323.59 / $537.03
| Professional | | $234.42 | $323.59 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $57.54 / $89.13
| Professional | 26 | $44.67 | $57.54 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $275.42 / $457.09
| Professional | TC | $190.55 | $275.42 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Facility | 26 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,137.96 / $2,137.96
| Professional | | $1,949.84 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $588.84
| Professional | 26 | $489.78 | $489.78 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,698.24 / $1,778.28 / $1,778.28
| Professional | TC | $1,698.24 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $316.23 / $524.81
| Professional | | $239.88 | $316.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $54.95 / $93.33
| Professional | 26 | $43.65 | $54.95 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $446.68
| Professional | TC | $204.17 | $269.15 | $446.68 |