- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $131.83 / $162.18
| Facility | 26 | $125.89 | $131.83 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $549.54 / $1,621.81
| Professional | | $426.58 | $549.54 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $269.15
| Professional | 26 | $100.00 | $141.25 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $389.05 / $851.14
| Professional | TC | $302.00 | $389.05 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $645.65 / $1,047.13
| Professional | | $446.68 | $645.65 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $144.54 / $281.84
| Professional | 26 | $102.33 | $144.54 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $436.52 / $933.25
| Professional | TC | $338.84 | $436.52 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $912.01 / $1,659.59
| Professional | | $549.54 | $912.01 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $141.25 / $229.09
| Professional | 26 | $107.15 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $724.44 / $1,288.25
| Professional | TC | $426.58 | $724.44 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,258.93 / $1,258.93
| Professional | | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Professional | 26 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $812.83 / $1,513.56
| Professional | | $524.81 | $812.83 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $131.83 / $223.87
| Professional | 26 | $104.71 | $131.83 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $691.83 / $1,318.26
| Professional | TC | $416.87 | $691.83 | $1,318.26 |