- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $323.59
| Facility | 26 | $79.43 | $125.89 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $371.54 / $1,000.00
| Professional | | $251.19 | $371.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $85.11 / $218.78
| Professional | 26 | $72.44 | $85.11 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $229.09 / $436.52
| Professional | TC | $165.96 | $229.09 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $263.03
| Professional | 26 | $102.33 | $102.33 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $660.69 / $933.25
| Professional | | $257.04 | $660.69 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $186.21 / $269.15
| Professional | 26 | $79.43 | $186.21 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $457.09 / $660.69
| Professional | TC | $177.83 | $457.09 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $645.65 / $1,380.38
| Professional | | $346.74 | $645.65 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $138.04 / $245.47
| Professional | 26 | $91.20 | $138.04 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $457.09 / $1,096.48
| Professional | TC | $245.47 | $457.09 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $501.19 / $758.58
| Professional | | $323.59 | $501.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $144.54 / $213.80
| Professional | 26 | $93.33 | $144.54 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $346.74 / $512.86
| Professional | TC | $229.09 | $346.74 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $512.86 / $977.24
| Professional | | $323.59 | $512.86 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $251.19
| Professional | 26 | $87.10 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $363.08 / $676.08
| Professional | TC | $229.09 | $363.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $67.61 / $81.28
| Facility | 26 | $61.66 | $67.61 | $81.28 |