- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Facility | 26 | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $354.81 / $524.81
| Professional | | $281.84 | $354.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $87.10 / $154.88
| Professional | 26 | $72.44 | $87.10 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $269.15 / $323.59
| Professional | TC | $208.93 | $269.15 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $741.31 / $912.01
| Professional | | $588.84 | $741.31 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $190.55 / $234.42
| Professional | 26 | $151.36 | $190.55 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $549.54 / $691.83
| Professional | TC | $436.52 | $549.54 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $660.69 / $3,388.44
| Professional | | $302.00 | $660.69 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $138.04 / $660.69
| Professional | 26 | $87.10 | $138.04 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $562.34 / $2,951.21
| Professional | TC | $323.59 | $562.34 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $660.69 / $794.33
| Professional | | $602.56 | $660.69 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $173.78 / $199.53
| Professional | 26 | $162.18 | $173.78 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $478.63 / $602.56
| Professional | TC | $446.68 | $478.63 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Professional | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Professional | 26 | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $537.03
| Professional | TC | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $588.84 / $912.01
| Professional | | $416.87 | $588.84 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $134.90 / $158.49
| Professional | 26 | $102.33 | $134.90 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $436.52 / $794.33
| Professional | TC | $309.03 | $436.52 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $691.83 / $1,000.00
| Professional | | $371.54 | $691.83 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $147.91 / $218.78
| Professional | 26 | $87.10 | $147.91 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $512.86 / $812.83
| Professional | TC | $275.42 | $512.86 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $812.83 / $812.83
| Professional | | $691.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $213.80 / $213.80
| Professional | 26 | $181.97 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $588.84 / $588.84
| Professional | TC | $501.19 | $588.84 | $588.84 |