- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Facility | 26 | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $346.74 / $691.83
| Professional | | $288.40 | $346.74 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $91.20 / $281.84
| Professional | 26 | $79.43 | $91.20 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $257.04 / $512.86
| Professional | TC | $190.55 | $257.04 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $398.11 / $616.60
| Professional | | $316.23 | $398.11 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $120.23 / $177.83
| Professional | 26 | $102.33 | $120.23 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $281.84 / $426.58
| Professional | TC | $208.93 | $281.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $630.96
| Professional | | $32.36 | $33.11 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $489.78
| Facility | 26 | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $524.81 / $776.25
| Professional | | $389.05 | $524.81 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $162.18 / $588.84
| Professional | 26 | $107.15 | $162.18 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $354.81 / $489.78
| Professional | TC | $281.84 | $354.81 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $489.78 / $676.08
| Professional | | $288.40 | $489.78 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $154.88 / $229.09
| Professional | 26 | $89.13 | $154.88 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $338.84 / $389.05
| Professional | TC | $199.53 | $338.84 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $263.03 / $524.81
| Professional | | $114.82 | $263.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $371.54 / $588.84
| Professional | | $269.15 | $371.54 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $102.33 / $158.49
| Professional | 26 | $79.43 | $102.33 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $251.19 / $407.38
| Professional | TC | $190.55 | $251.19 | $407.38 |