- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Facility | 26 | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $346.74 / $562.34
| Professional | | $239.88 | $346.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $91.20 / $190.55
| Professional | 26 | $70.79 | $91.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $223.87 / $380.19
| Professional | TC | $169.82 | $223.87 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $707.95 / $1,023.29
| Professional | | $263.03 | $707.95 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $190.55 / $275.42
| Professional | 26 | $83.18 | $190.55 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $512.86 / $741.31
| Professional | TC | $177.83 | $512.86 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $676.08 / $1,174.90
| Professional | | $363.08 | $676.08 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $141.25 / $251.19
| Professional | 26 | $95.50 | $141.25 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $489.78 / $954.99
| Professional | TC | $257.04 | $489.78 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $562.34 / $831.76
| Professional | | $354.81 | $562.34 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $147.91 / $218.78
| Professional | 26 | $95.50 | $147.91 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $398.11 / $588.84
| Professional | TC | $257.04 | $398.11 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $549.54 / $1,000.00
| Professional | | $354.81 | $549.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $128.82 / $251.19
| Professional | 26 | $91.20 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $398.11 / $707.95
| Professional | TC | $257.04 | $398.11 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $69.18 / $83.18
| Facility | 26 | $63.10 | $69.18 | $83.18 |