- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $107.15 / $173.78
| Facility | 26 | $104.71 | $107.15 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $457.09 / $977.24
| Professional | | $234.42 | $457.09 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $169.82 / $288.40
| Professional | 26 | $102.33 | $169.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $416.87 / $776.25
| Professional | TC | $281.84 | $416.87 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $912.01 / $1,000.00
| Professional | | $676.08 | $912.01 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $234.42 / $263.03
| Professional | 26 | $177.83 | $234.42 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $676.08 / $741.31
| Professional | TC | $501.19 | $676.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $758.58 / $1,288.25
| Professional | | $489.78 | $758.58 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $263.03
| Professional | 26 | $104.71 | $165.96 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $562.34 / $1,047.13
| Professional | TC | $371.54 | $562.34 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Facility | 26 | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $891.25 / $6,025.60
| Professional | | $457.09 | $891.25 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $199.53 / $891.25
| Professional | 26 | $107.15 | $199.53 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $691.83 / $5,495.41
| Professional | TC | $346.74 | $691.83 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $676.08 / $1,096.48
| Professional | | $100.00 | $676.08 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $177.83 / $275.42
| Professional | 26 | $100.00 | $177.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $645.65 / $1,023.29
| Professional | TC | $346.74 | $645.65 | $1,023.29 |