- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $74.13 / $125.89
| Facility | 26 | $53.70 | $74.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $446.68 / $776.25
| Professional | | $323.59 | $446.68 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $154.88
| Professional | 26 | $64.57 | $75.86 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $363.08 / $645.65
| Professional | TC | $263.03 | $363.08 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $891.25 / $1,000.00
| Professional | | $676.08 | $891.25 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $165.96 / $186.21
| Professional | 26 | $125.89 | $165.96 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $724.44 / $812.83
| Professional | TC | $549.54 | $724.44 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $616.60 / $933.25
| Professional | | $389.05 | $616.60 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $134.90 / $177.83
| Professional | 26 | $91.20 | $134.90 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $501.19 / $776.25
| Professional | TC | $309.03 | $501.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $812.83 / $2,691.53
| Professional | | $416.87 | $812.83 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $144.54 / $457.09
| Professional | 26 | $79.43 | $144.54 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $676.08 / $2,238.72
| Professional | TC | $323.59 | $676.08 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $794.33 / $1,096.48
| Professional | | $389.05 | $794.33 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $141.25 / $199.53
| Professional | 26 | $72.44 | $141.25 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $660.69 / $912.01
| Professional | TC | $323.59 | $660.69 | $912.01 |