- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $107.15 / $269.15
| Facility | 26 | $37.15 | $107.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $380.19 / $630.96
| Professional | | $245.47 | $380.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $100.00
| Professional | 26 | $32.36 | $57.54 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $562.34
| Professional | TC | $218.78 | $338.84 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $676.08 / $1,412.54
| Professional | | $446.68 | $676.08 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Professional | 26 | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Professional | TC | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $724.44 / $2,041.74
| Professional | | $354.81 | $724.44 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $61.66 / $186.21
| Professional | 26 | $35.48 | $61.66 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $660.69 / $1,862.09
| Professional | TC | $323.59 | $660.69 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $489.78 / $977.24
| Professional | | $426.58 | $489.78 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $48.98 / $91.20
| Professional | 26 | $42.66 | $48.98 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $446.68 / $870.96
| Professional | TC | $380.19 | $446.68 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $660.69 / $1,412.54
| Professional | | $398.11 | $660.69 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $60.26 / $138.04
| Professional | 26 | $33.88 | $60.26 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $602.56 / $1,288.25
| Professional | TC | $363.08 | $602.56 | $1,288.25 |