- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $131.83 / $181.97
| Facility | 26 | $100.00 | $131.83 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $501.19 / $1,862.09
| Professional | | $275.42 | $501.19 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $331.13
| Professional | 26 | $100.00 | $154.88 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $363.08 / $954.99
| Professional | TC | $269.15 | $363.08 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $95.50 / $120.23
| Professional | 26 | $75.86 | $95.50 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Professional | TC | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $512.86 / $812.83
| Professional | | $426.58 | $512.86 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $117.49 / $165.96
| Professional | 26 | $93.33 | $117.49 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $371.54 / $676.08
| Professional | TC | $323.59 | $371.54 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $131.83 / $158.49
| Professional | | $93.33 | $131.83 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $117.49 / $165.96
| Facility | 26 | $25.12 | $117.49 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $912.01 / $4,466.84
| Professional | | $457.09 | $912.01 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $162.18 / $501.19
| Professional | 26 | $93.33 | $162.18 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $776.25 / $2,290.87
| Professional | TC | $331.13 | $776.25 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $676.08
| Professional | | $32.36 | $33.11 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $707.95 / $1,202.26
| Professional | | $398.11 | $707.95 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $109.65 / $186.21
| Professional | 26 | $95.50 | $109.65 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $562.34 / $912.01
| Professional | TC | $295.12 | $562.34 | $912.01 |