- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $223.87 / $537.03
| Facility | 26 | $72.44 | $223.87 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $524.81 / $1,479.11
| Professional | | $338.84 | $524.81 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $93.33 / $229.09
| Professional | 26 | $60.26 | $93.33 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $426.58 / $1,174.90
| Professional | TC | $281.84 | $426.58 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $933.25 / $1,949.84
| Professional | | $89.13 | $933.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Professional | TC | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $562.34 / $1,862.09
| Professional | | $398.11 | $562.34 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $120.23 / $309.03
| Professional | 26 | $70.79 | $120.23 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $489.78 / $1,584.89
| Professional | TC | $331.13 | $489.78 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $575.44 / $1,071.52
| Professional | | $489.78 | $575.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $100.00 / $181.97
| Professional | 26 | $87.10 | $100.00 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $407.38 / $467.74 / $912.01
| Professional | TC | $407.38 | $467.74 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $741.31 / $1,513.56
| Professional | | $407.38 | $741.31 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $112.20 / $257.04
| Professional | 26 | $60.26 | $112.20 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $616.60 / $1,258.93
| Professional | TC | $354.81 | $616.60 | $1,258.93 |