- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $239.88 / $281.84
| Facility | 26 | $117.49 | $239.88 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $794.33
| Professional | | $204.17 | $302.00 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $72.44 / $169.82
| Professional | 26 | $54.95 | $72.44 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $218.78 / $457.09
| Professional | TC | $147.91 | $218.78 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $478.63 / $977.24
| Professional | | $229.09 | $478.63 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $123.03 / $181.97
| Professional | 26 | $58.88 | $123.03 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $346.74 / $758.58
| Professional | TC | $165.96 | $346.74 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $489.78 / $812.83
| Professional | | $309.03 | $489.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $97.72 / $177.83
| Professional | 26 | $72.44 | $97.72 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $371.54 / $616.60
| Professional | TC | $229.09 | $371.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $457.09 / $616.60
| Professional | | $302.00 | $457.09 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $79.43 / $107.15
| Professional | 26 | $74.13 | $79.43 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $263.03 / $389.05
| Professional | TC | $208.93 | $263.03 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $346.74
| Professional | | $85.11 | $85.11 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $323.59 / $707.95
| Professional | | $213.80 | $323.59 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $77.62 / $173.78
| Professional | 26 | $54.95 | $77.62 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $239.88 / $549.54
| Professional | TC | $158.49 | $239.88 | $549.54 |