- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | 26 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $295.12 / $891.25
| Professional | | $194.98 | $295.12 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $223.87
| Professional | 26 | $54.95 | $91.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $204.17 / $549.54
| Professional | TC | $120.23 | $204.17 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $691.83 / $912.01
| Professional | | $323.59 | $691.83 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $134.90 / $288.40
| Professional | 26 | $64.57 | $134.90 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $457.09 / $645.65
| Professional | TC | $218.78 | $457.09 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | 26 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $630.96 / $1,445.44
| Professional | | $309.03 | $630.96 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $223.87 / $549.54
| Professional | 26 | $91.20 | $223.87 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $398.11 / $891.25
| Professional | TC | $218.78 | $398.11 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $912.01 / $1,548.82
| Professional | | $912.01 | $912.01 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $302.00 / $489.78
| Professional | 26 | $269.15 | $302.00 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $616.60 / $1,023.29
| Professional | TC | $575.44 | $616.60 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $562.34 / $851.14
| Professional | | $389.05 | $562.34 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $134.90 / $288.40
| Professional | 26 | $64.57 | $134.90 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $436.52 / $676.08
| Professional | TC | $151.36 | $436.52 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $602.56 / $1,819.70
| Professional | | $295.12 | $602.56 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $229.09 / $549.54
| Professional | 26 | $83.18 | $229.09 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $457.09 / $1,202.26
| Professional | TC | $199.53 | $457.09 | $1,202.26 |