- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $154.88
| Facility | 26 | $97.72 | $97.72 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $190.55 / $436.52
| Professional | | $162.18 | $190.55 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $104.71 / $208.93
| Professional | 26 | $93.33 | $104.71 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $125.89
| Professional | TC | $64.57 | $75.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $204.17 / $204.17
| Professional | | $169.82 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | 26 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $177.83 / $245.47
| Professional | | $104.71 | $177.83 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $245.47 / $288.40
| Professional | | $181.97 | $245.47 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $141.25 / $173.78
| Professional | 26 | $102.33 | $141.25 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $117.49
| Professional | TC | $70.79 | $97.72 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $467.74 / $467.74
| Facility | 26 | $239.88 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $213.80 / $1,148.15
| Professional | | $162.18 | $213.80 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $123.03 / $660.69
| Professional | 26 | $93.33 | $123.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $93.33 / $478.63
| Professional | TC | $70.79 | $93.33 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $204.17 / $302.00
| Professional | | $154.88 | $204.17 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $117.49 / $173.78
| Professional | 26 | $89.13 | $117.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $89.13 / $125.89
| Professional | TC | $67.61 | $89.13 | $125.89 |