- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $60.26 / $100.00
| Facility | 26 | $47.86 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $281.84 / $501.19
| Professional | | $186.21 | $281.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $154.88
| Professional | 26 | $52.48 | $79.43 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $213.80 / $354.81
| Professional | TC | $131.83 | $213.80 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $457.09 / $512.86
| Professional | | $346.74 | $457.09 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $134.90 / $151.36
| Professional | 26 | $102.33 | $134.90 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $323.59 / $363.08
| Professional | TC | $245.47 | $323.59 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $389.05 / $660.69
| Professional | | $251.19 | $389.05 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $95.50 / $154.88
| Professional | 26 | $63.10 | $95.50 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $275.42 / $489.78
| Professional | TC | $173.78 | $275.42 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | 26 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $467.74 / $2,344.23
| Professional | | $234.42 | $467.74 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $125.89 / $537.03
| Professional | 26 | $67.61 | $125.89 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $354.81 / $1,995.26
| Professional | TC | $165.96 | $354.81 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $346.74 / $562.34
| Professional | | $100.00 | $346.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $107.15 / $162.18
| Professional | 26 | $69.18 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $316.23 / $436.52
| Professional | TC | $165.96 | $316.23 | $436.52 |