- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $295.12 / $371.54 / $407.38
| Facility | 26 | $295.12 | $371.54 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $478.63 / $1,071.52
| Professional | | $346.74 | $478.63 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $354.81
| Professional | 26 | $85.11 | $125.89 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $338.84 / $691.83
| Professional | TC | $257.04 | $338.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $489.78 / $776.25
| Professional | | $389.05 | $489.78 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $107.15 / $169.82
| Professional | 26 | $85.11 | $107.15 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $380.19 / $616.60
| Professional | TC | $309.03 | $380.19 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $97.72 / $138.04
| Facility | 26 | $20.89 | $97.72 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $501.19 / $891.25
| Professional | | $281.84 | $501.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $100.00 / $186.21
| Professional | 26 | $67.61 | $100.00 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $371.54 / $724.44
| Professional | TC | $218.78 | $371.54 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $616.60 / $794.33 / $794.33
| Facility | 26 | $616.60 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $501.19 / $3,019.95
| Professional | | $331.13 | $501.19 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $93.33 / $851.14
| Professional | 26 | $74.13 | $93.33 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $436.52 / $2,570.40
| Professional | TC | $257.04 | $436.52 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $457.09 / $812.83
| Professional | | $302.00 | $457.09 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $89.13 / $208.93
| Professional | 26 | $74.13 | $89.13 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $602.56
| Professional | TC | $257.04 | $363.08 | $602.56 |