- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $131.83 / $165.96
| Facility | 26 | $104.71 | $131.83 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $478.63 / $1,174.90
| Professional | | $245.47 | $478.63 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $165.96 / $338.84
| Professional | 26 | $102.33 | $165.96 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $363.08 / $851.14
| Professional | TC | $281.84 | $363.08 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $338.84 / $354.81
| Professional | | $302.00 | $338.84 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $95.50 / $186.21
| Professional | 26 | $77.62 | $95.50 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Professional | TC | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $549.54 / $851.14
| Professional | | $407.38 | $549.54 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $109.65 / $162.18
| Professional | 26 | $95.50 | $109.65 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $446.68 / $691.83
| Professional | TC | $309.03 | $446.68 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $724.44 / $1,412.54
| Professional | | $389.05 | $724.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $239.88
| Professional | 26 | $89.13 | $138.04 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $562.34 / $1,202.26
| Professional | TC | $288.40 | $562.34 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $575.44 / $1,230.27
| Professional | | $380.19 | $575.44 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $112.20 / $234.42
| Professional | 26 | $91.20 | $112.20 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $436.52 / $1,000.00
| Professional | TC | $295.12 | $436.52 | $1,000.00 |