- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | 26 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $371.54 / $1,047.13
| Professional | | $234.42 | $371.54 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $186.21
| Professional | 26 | $57.54 | $89.13 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $263.03 / $794.33
| Professional | TC | $173.78 | $263.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $758.58 / $1,047.13
| Professional | | $338.84 | $758.58 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $112.20 / $309.03
| Professional | 26 | $47.86 | $112.20 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $549.54 / $812.83
| Professional | TC | $263.03 | $549.54 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | 26 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $660.69 / $1,445.44
| Professional | | $457.09 | $660.69 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $165.96 / $416.87
| Professional | 26 | $102.33 | $165.96 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $501.19 / $1,023.29
| Professional | TC | $346.74 | $501.19 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,071.52 / $1,659.59
| Professional | | $954.99 | $1,071.52 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $204.17 / $229.09 / $380.19
| Professional | 26 | $204.17 | $229.09 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $812.83 / $1,258.93
| Professional | TC | $724.44 | $812.83 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $588.84 / $1,023.29
| Professional | | $407.38 | $588.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $181.97 / $309.03
| Professional | 26 | $56.23 | $181.97 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $549.54 / $1,000.00
| Professional | TC | $199.53 | $549.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $630.96 / $1,548.82
| Professional | | $323.59 | $630.96 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $169.82 / $338.84
| Professional | 26 | $63.10 | $169.82 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $457.09 / $1,174.90
| Professional | TC | $245.47 | $457.09 | $1,174.90 |