- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $363.08
| Facility | 26 | $186.21 | $309.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $457.09 / $1,513.56
| Professional | | $169.82 | $457.09 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $141.25 / $281.84
| Professional | 26 | $77.62 | $141.25 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $338.84 / $724.44
| Professional | TC | $245.47 | $338.84 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $724.44 / $1,258.93
| Professional | | $331.13 | $724.44 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $144.54 / $204.17
| Professional | 26 | $74.13 | $144.54 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $562.34 / $1,071.52
| Professional | TC | $257.04 | $562.34 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $758.58 / $1,096.48
| Professional | | $457.09 | $758.58 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $114.82 / $229.09
| Professional | 26 | $72.44 | $114.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $630.96 / $933.25
| Professional | TC | $338.84 | $630.96 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $724.44 / $1,148.15
| Professional | | $446.68 | $724.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $102.33 / $123.03
| Professional | 26 | $83.18 | $102.33 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $416.87 / $616.60
| Professional | TC | $331.13 | $416.87 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $138.04 / $173.78
| Professional | | $123.03 | $138.04 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $489.78 / $1,348.96
| Professional | | $316.23 | $489.78 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $281.84
| Professional | 26 | $70.79 | $97.72 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $380.19 / $1,000.00
| Professional | TC | $245.47 | $380.19 | $1,000.00 |