- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $199.53 / $257.04
| Facility | 26 | $95.50 | $199.53 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $281.84 / $436.52
| Professional | | $239.88 | $281.84 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $102.33 / $144.54
| Professional | 26 | $91.20 | $102.33 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $177.83 / $302.00
| Professional | TC | $141.25 | $177.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $316.23 / $616.60
| Professional | | $257.04 | $316.23 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $147.91 / $223.87
| Professional | 26 | $107.15 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $239.88 / $512.86
| Professional | TC | $158.49 | $239.88 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $323.59 / $645.65
| Professional | | $223.87 | $323.59 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $131.83 / $218.78
| Professional | 26 | $100.00 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $204.17 / $436.52
| Professional | TC | $104.71 | $204.17 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Facility | 26 | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,454.71 / $2,454.71
| Professional | | $1,995.26 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $741.31 / $794.33 / $794.33
| Professional | 26 | $741.31 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,584.89 / $1,621.81 / $1,621.81
| Professional | TC | $1,584.89 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $323.59 / $524.81
| Professional | | $208.93 | $323.59 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $123.03 / $204.17
| Professional | 26 | $93.33 | $123.03 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $199.53 / $371.54
| Professional | TC | $117.49 | $199.53 | $371.54 |