- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $436.52 / $524.81
| Facility | 26 | $194.98 | $436.52 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $1,000.00
| Professional | | $269.15 | $389.05 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $154.88 / $380.19
| Professional | 26 | $95.50 | $154.88 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $229.09 / $562.34
| Professional | TC | $158.49 | $229.09 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $812.83 / $1,174.90
| Professional | | $295.12 | $812.83 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $213.80 / $302.00
| Professional | 26 | $109.65 | $213.80 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $588.84 / $851.14
| Professional | TC | $186.21 | $588.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $870.96 / $1,348.96
| Professional | | $457.09 | $870.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $162.18 / $295.12
| Professional | 26 | $117.49 | $162.18 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $676.08 / $1,096.48
| Professional | TC | $346.74 | $676.08 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $724.44 / $1,023.29
| Professional | | $407.38 | $724.44 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $147.91 / $177.83
| Professional | 26 | $123.03 | $147.91 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $309.03 / $575.44
| Professional | TC | $245.47 | $309.03 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $199.53 / $229.09
| Professional | | $158.49 | $199.53 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $512.86 / $1,230.27
| Professional | | $346.74 | $512.86 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $323.59
| Professional | 26 | $100.00 | $141.25 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $371.54 / $912.01
| Professional | TC | $234.42 | $371.54 | $912.01 |