- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $295.12 / $331.13
| Facility | 26 | $120.23 | $295.12 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $245.47 / $512.86
| Professional | | $199.53 | $245.47 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $169.82 / $309.03
| Professional | 26 | $120.23 | $169.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $93.33 / $141.25
| Professional | TC | $77.62 | $93.33 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $186.21 / $245.47
| Professional | | $79.43 | $186.21 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $144.54
| Professional | 26 | $107.15 | $107.15 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $100.00
| Professional | TC | $79.43 | $89.13 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $331.13 / $851.14
| Professional | | $194.98 | $331.13 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $199.53 / $524.81
| Professional | 26 | $120.23 | $199.53 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $141.25 / $331.13
| Professional | TC | $77.62 | $141.25 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $275.42 / $489.78
| Professional | | $234.42 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $162.18 / $288.40
| Professional | 26 | $138.04 | $162.18 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $112.20 / $213.80
| Professional | TC | $97.72 | $112.20 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $346.74 / $645.65
| Professional | | $218.78 | $346.74 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $208.93 / $363.08
| Professional | 26 | $120.23 | $208.93 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $144.54 / $263.03
| Professional | TC | $95.50 | $144.54 | $263.03 |