- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $288.40 / $446.68
| Facility | 26 | $117.49 | $288.40 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $467.74 / $1,174.90
| Professional | | $338.84 | $467.74 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $125.89 / $257.04
| Professional | 26 | $70.79 | $125.89 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $363.08 / $870.96
| Professional | TC | $263.03 | $363.08 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $446.68 / $3,715.35
| Professional | | $363.08 | $446.68 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $95.50 / $95.50
| Professional | 26 | $85.11 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $363.08 / $588.84
| Professional | TC | $354.81 | $363.08 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $891.25 / $1,584.89
| Professional | | $457.09 | $891.25 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $100.00 / $199.53
| Professional | 26 | $58.88 | $100.00 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $724.44 / $1,479.11
| Professional | TC | $363.08 | $724.44 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $380.19 / $851.14
| Professional | | $323.59 | $380.19 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $74.13 / $154.88
| Professional | 26 | $63.10 | $74.13 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $309.03 / $707.95
| Professional | TC | $263.03 | $309.03 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $398.11 / $3,388.44
| Professional | | $95.50 | $398.11 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $245.47 / $537.03
| Professional | 26 | $67.61 | $245.47 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $478.63 / $1,778.28
| Professional | TC | $269.15 | $478.63 | $1,778.28 |