- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $125.89 / $151.36
| Facility | 26 | $114.82 | $125.89 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $213.80 / $436.52
| Professional | | $162.18 | $213.80 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $120.23 / $229.09
| Professional | 26 | $93.33 | $120.23 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $81.28 / $125.89
| Professional | TC | $67.61 | $81.28 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $165.96 / $229.09
| Professional | | $154.88 | $165.96 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $117.49 / $120.23
| Professional | 26 | $93.33 | $117.49 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $204.17 / $229.09
| Professional | | $173.78 | $204.17 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $123.03 / $134.90
| Professional | 26 | $104.71 | $123.03 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $83.18 / $93.33
| Professional | TC | $69.18 | $83.18 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $144.54 / $144.54
| Professional | 26 | $39.81 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $346.74
| Professional | | $162.18 | $223.87 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $128.82 / $199.53
| Professional | 26 | $100.00 | $128.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $89.13 / $151.36
| Professional | TC | $61.66 | $89.13 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $338.84
| Professional | | $154.88 | $194.98 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $112.20 / $190.55
| Professional | 26 | $89.13 | $112.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $131.83
| Professional | TC | $67.61 | $85.11 | $131.83 |