- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Facility | 26 | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $380.19 / $851.14
| Professional | | $323.59 | $380.19 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $134.90 / $239.88
| Professional | 26 | $100.00 | $134.90 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $269.15 / $616.60
| Professional | TC | $223.87 | $269.15 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $416.87 / $741.31
| Professional | | $363.08 | $416.87 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $147.91 / $218.78
| Professional | 26 | $123.03 | $147.91 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $281.84 / $467.74
| Professional | TC | $218.78 | $281.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $416.87
| Professional | | $32.36 | $33.11 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | 26 | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $575.44 / $660.69
| Professional | | $478.63 | $575.44 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $190.55 / $245.47
| Professional | 26 | $134.90 | $190.55 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $389.05 / $426.58
| Professional | TC | $323.59 | $389.05 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $602.56 / $691.83
| Professional | | $354.81 | $602.56 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $190.55 / $245.47
| Professional | 26 | $112.20 | $190.55 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $416.87 / $457.09
| Professional | TC | $239.88 | $416.87 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $354.81 / $537.03
| Professional | | $151.36 | $354.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $389.05 / $707.95
| Professional | | $309.03 | $389.05 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $134.90 / $194.98
| Professional | 26 | $102.33 | $134.90 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $251.19 / $436.52
| Professional | TC | $194.98 | $251.19 | $436.52 |