- 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
- $363.08 / $478.63 / $2,238.72
| Professional | | $363.08 | $478.63 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $194.98 / $549.54
| Professional | 26 | $102.33 | $194.98 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $575.44
| Professional | TC | $218.78 | $338.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $478.63 / $776.25
| Professional | | $323.59 | $478.63 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $134.90 / $234.42
| Professional | 26 | $97.72 | $134.90 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $316.23 / $549.54
| Professional | TC | $229.09 | $316.23 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $851.14
| Professional | | $32.36 | $33.11 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $588.84 / $794.33
| Professional | | $489.78 | $588.84 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $177.83 / $251.19
| Professional | 26 | $151.36 | $177.83 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $407.38 / $549.54
| Professional | TC | $346.74 | $407.38 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $537.03 / $707.95
| Professional | | $323.59 | $537.03 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $173.78 / $257.04
| Professional | 26 | $104.71 | $173.78 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $363.08 / $457.09
| Professional | TC | $218.78 | $363.08 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $363.08 / $660.69
| Professional | | $154.88 | $363.08 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $501.19 / $1,000.00
| Professional | | $346.74 | $501.19 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $177.83
| Professional | 26 | $70.79 | $100.00 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $407.38 / $1,071.52
| Professional | TC | $245.47 | $407.38 | $1,071.52 |