- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $165.96 / $398.11
| Facility | 26 | $114.82 | $165.96 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $501.19
| Professional | | $204.17 | $269.15 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $123.03 / $239.88
| Professional | 26 | $85.11 | $123.03 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $131.83 / $295.12
| Professional | TC | $100.00 | $131.83 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $104.71
| Professional | 26 | $87.10 | $87.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Professional | TC | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $371.54 / $616.60
| Professional | | $295.12 | $371.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $141.25 / $229.09
| Professional | 26 | $109.65 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $229.09 / $389.05
| Professional | TC | $151.36 | $229.09 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $537.03 / $1,000.00
| Professional | | $363.08 | $537.03 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $147.91 / $263.03
| Professional | 26 | $91.20 | $147.91 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $389.05 / $758.58
| Professional | TC | $263.03 | $389.05 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $128.82 / $186.21
| Facility | 26 | $27.54 | $128.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $524.81 / $912.01
| Professional | | $354.81 | $524.81 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $147.91 / $245.47
| Professional | 26 | $91.20 | $147.91 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $389.05 / $616.60
| Professional | TC | $257.04 | $389.05 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $100.00
| Professional | | $32.36 | $33.11 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | 26 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $263.03 / $467.74
| Professional | | $208.93 | $263.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $134.90 / $239.88
| Professional | 26 | $107.15 | $134.90 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $125.89 / $229.09
| Professional | TC | $102.33 | $125.89 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $489.78 / $831.76
| Professional | | $338.84 | $489.78 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $125.89 / $245.47
| Professional | 26 | $91.20 | $125.89 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $363.08 / $630.96
| Professional | TC | $245.47 | $363.08 | $630.96 |