- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $213.80 / $524.81
| Facility | 26 | $74.13 | $213.80 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $338.84 / $1,778.28
| Professional | | $239.88 | $338.84 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $107.15 / $257.04
| Professional | 26 | $74.13 | $107.15 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $213.80 / $562.34
| Professional | TC | $162.18 | $213.80 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $398.11 / $2,187.76
| Professional | | $95.50 | $398.11 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $95.50 / $107.15
| Professional | 26 | $91.20 | $95.50 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $288.40 / $346.74
| Professional | TC | $257.04 | $288.40 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $549.54 / $1,230.27
| Professional | | $346.74 | $549.54 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $234.42
| Professional | 26 | $64.57 | $100.00 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $416.87 / $954.99
| Professional | TC | $245.47 | $416.87 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $316.23 / $676.08
| Professional | | $269.15 | $316.23 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $87.10 / $181.97
| Professional | 26 | $74.13 | $87.10 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $229.09 / $489.78
| Professional | TC | $194.98 | $229.09 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $263.03 / $1,047.13
| Professional | | $95.50 | $263.03 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $208.93 / $512.86
| Professional | 26 | $77.62 | $208.93 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $1,202.26
| Professional | TC | $186.21 | $309.03 | $1,202.26 |