- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $169.82
| Facility | 26 | $141.25 | $141.25 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $478.63 / $1,000.00
| Professional | | $309.03 | $478.63 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $141.25 / $269.15
| Professional | 26 | $85.11 | $141.25 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $331.13 / $588.84
| Professional | TC | $208.93 | $331.13 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $64.57 / $123.03
| Professional | 26 | $63.10 | $64.57 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $309.03 / $478.63
| Professional | | $269.15 | $309.03 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $79.43 / $138.04
| Professional | 26 | $77.62 | $79.43 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $218.78 / $398.11
| Professional | TC | $190.55 | $218.78 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $467.74 / $851.14
| Professional | | $275.42 | $467.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $109.65 / $158.49
| Professional | 26 | $70.79 | $109.65 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $338.84 / $724.44
| Professional | TC | $194.98 | $338.84 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $346.74 / $467.74
| Professional | | $5.62 | $346.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.07 / $97.72 / $128.82
| Professional | 26 | $1.07 | $97.72 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $245.47 / $354.81
| Professional | TC | $22.39 | $245.47 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $5.62 / $398.11
| Professional | | $5.62 | $5.62 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.07 / $1.07 / $123.03
| Professional | 26 | $1.07 | $1.07 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.47 / $281.84 / $295.12
| Professional | TC | $4.47 | $281.84 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $269.15 / $288.40
| Professional | | $257.04 | $269.15 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $81.28 / $85.11
| Professional | 26 | $79.43 | $81.28 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $186.21 / $199.53
| Professional | TC | $173.78 | $186.21 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $398.11 / $812.83
| Professional | | $234.42 | $398.11 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $81.28 / $162.18
| Professional | 26 | $64.57 | $81.28 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $295.12 / $691.83
| Professional | TC | $186.21 | $295.12 | $691.83 |