- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $288.40 / $645.65
| Facility | 26 | $117.49 | $288.40 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $478.63 / $1,258.93
| Professional | | $223.87 | $478.63 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $181.97 / $354.81
| Professional | 26 | $102.33 | $181.97 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $407.38 / $1,000.00
| Professional | TC | $281.84 | $407.38 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $549.54 / $3,715.35
| Professional | | $125.89 | $549.54 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $141.25
| Professional | 26 | $100.00 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $426.58 / $588.84
| Professional | TC | $416.87 | $426.58 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $891.25 / $1,412.54
| Professional | | $407.38 | $891.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $123.03 / $288.40
| Professional | 26 | $79.43 | $123.03 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $724.44 / $1,258.93
| Professional | TC | $323.59 | $724.44 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $467.74 / $1,023.29
| Professional | | $398.11 | $467.74 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $107.15 / $223.87
| Professional | 26 | $91.20 | $107.15 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $363.08 / $812.83
| Professional | TC | $309.03 | $363.08 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $588.84 / $3,548.13
| Professional | | $95.50 | $588.84 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $186.21 / $630.96
| Professional | 26 | $95.50 | $186.21 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $549.54 / $1,862.09
| Professional | TC | $323.59 | $549.54 | $1,862.09 |