- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Facility | 26 | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $426.58 / $870.96
| Professional | | $251.19 | $426.58 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $120.23 / $263.03
| Professional | 26 | $72.44 | $120.23 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $660.69
| Professional | TC | $186.21 | $309.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $123.03
| Professional | 26 | $54.95 | $54.95 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $371.54 / $398.11
| Professional | | $125.89 | $371.54 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $151.36
| Professional | 26 | $112.20 | $112.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $489.78 / $831.76
| Professional | | $251.19 | $489.78 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $89.13 / $177.83
| Professional | 26 | $53.70 | $89.13 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $354.81 / $645.65
| Professional | TC | $181.97 | $354.81 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $117.49 / $138.04
| Facility | 26 | $50.12 | $117.49 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $446.68 / $831.76
| Professional | | $263.03 | $446.68 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $93.33 / $208.93
| Professional | 26 | $53.70 | $93.33 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $346.74 / $691.83
| Professional | TC | $194.98 | $346.74 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $426.58 / $812.83
| Professional | | $251.19 | $426.58 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $141.25
| Professional | 26 | $52.48 | $79.43 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $331.13 / $616.60
| Professional | TC | $181.97 | $331.13 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $724.44
| Professional | | $251.19 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $79.43 / $354.81
| Professional | 26 | $57.54 | $79.43 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $338.84 / $630.96
| Professional | TC | $181.97 | $338.84 | $630.96 |