- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $173.78 / $208.93
| Facility | 26 | $123.03 | $173.78 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $549.54 / $870.96
| Professional | | $331.13 | $549.54 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $158.49 / $346.74
| Professional | 26 | $97.72 | $158.49 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $380.19 / $602.56
| Professional | TC | $229.09 | $380.19 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Professional | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $131.83
| Professional | 26 | $77.62 | $77.62 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Professional | TC | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $354.81 / $478.63
| Professional | | $104.71 | $354.81 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $165.96
| Facility | 26 | $104.71 | $104.71 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $588.84 / $977.24
| Professional | | $323.59 | $588.84 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $109.65 / $173.78
| Professional | 26 | $89.13 | $109.65 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $407.38 / $851.14
| Professional | TC | $223.87 | $407.38 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $758.58 / $977.24 / $977.24
| Facility | 26 | $758.58 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $512.86 / $6,025.60
| Professional | | $346.74 | $512.86 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $117.49 / $891.25
| Professional | 26 | $91.20 | $117.49 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $489.78 / $5,495.41
| Professional | TC | $245.47 | $489.78 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $436.52 / $1,000.00
| Professional | | $316.23 | $436.52 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $112.20 / $213.80
| Professional | 26 | $91.20 | $112.20 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $316.23 / $891.25
| Professional | TC | $234.42 | $316.23 | $891.25 |