- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $138.04 / $173.78
| Facility | 26 | $125.89 | $138.04 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $602.56 / $1,659.59
| Professional | | $426.58 | $602.56 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $158.49 / $331.13
| Professional | 26 | $109.65 | $158.49 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $436.52 / $870.96
| Professional | TC | $331.13 | $436.52 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Professional | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $162.18 / $199.53
| Professional | 26 | $81.28 | $162.18 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Professional | TC | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $575.44 / $891.25
| Professional | | $478.63 | $575.44 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $107.15 / $173.78
| Professional | 26 | $100.00 | $107.15 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $467.74 / $707.95
| Professional | TC | $371.54 | $467.74 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $851.14 / $1,513.56
| Professional | | $467.74 | $851.14 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $144.54 / $251.19
| Professional | 26 | $93.33 | $144.54 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $676.08 / $1,288.25
| Professional | TC | $371.54 | $676.08 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $707.95 / $1,288.25
| Professional | | $467.74 | $707.95 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $117.49 / $245.47
| Professional | 26 | $95.50 | $117.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $562.34 / $1,122.02
| Professional | TC | $380.19 | $562.34 | $1,122.02 |