- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $60.26
| Facility | 26 | $57.54 | $57.54 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $407.38 / $741.31
| Professional | | $323.59 | $407.38 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $269.15
| Professional | 26 | $53.70 | $72.44 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $346.74 / $776.25
| Professional | TC | $263.03 | $346.74 | $776.25 |
- 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
- $97.72 / $128.82 / $141.25
| Professional | 26 | $97.72 | $128.82 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $758.58 / $851.14
| Professional | TC | $575.44 | $758.58 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $776.25 / $1,096.48
| Professional | | $323.59 | $776.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $114.82 / $162.18
| Professional | 26 | $64.57 | $114.82 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $645.65 / $933.25
| Professional | TC | $257.04 | $645.65 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $691.83 / $2,454.71
| Professional | | $380.19 | $691.83 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $112.20 / $354.81
| Professional | 26 | $69.18 | $112.20 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $575.44 / $2,089.30
| Professional | TC | $331.13 | $575.44 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $691.83 / $1,023.29
| Professional | | $371.54 | $691.83 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $107.15 / $147.91
| Professional | 26 | $58.88 | $107.15 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $575.44 / $870.96
| Professional | TC | $309.03 | $575.44 | $870.96 |