- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $338.84 / $398.11
| Facility | 26 | $186.21 | $338.84 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $426.58 / $1,047.13
| Professional | | $281.84 | $426.58 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $141.25 / $295.12
| Professional | 26 | $85.11 | $141.25 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $302.00 / $660.69
| Professional | TC | $194.98 | $302.00 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $676.08 / $1,258.93
| Professional | | $281.84 | $676.08 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $169.82 / $239.88
| Professional | 26 | $83.18 | $169.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $478.63 / $1,023.29
| Professional | TC | $199.53 | $478.63 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $758.58 / $1,122.02
| Professional | | $380.19 | $758.58 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $128.82 / $251.19
| Professional | 26 | $97.72 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $602.56 / $831.76
| Professional | TC | $275.42 | $602.56 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $758.58 / $912.01
| Professional | | $389.05 | $758.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $114.82 / $141.25
| Professional | 26 | $97.72 | $114.82 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $331.13 / $660.69
| Professional | TC | $263.03 | $331.13 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $426.58 / $1,174.90
| Professional | | $275.42 | $426.58 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $109.65 / $323.59
| Professional | 26 | $77.62 | $109.65 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $302.00 / $1,000.00
| Professional | TC | $194.98 | $302.00 | $1,000.00 |