- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $173.78 / $190.55
| Facility | 26 | $120.23 | $173.78 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $1,348.96
| Professional | | $316.23 | $478.63 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $169.82 / $371.54
| Professional | 26 | $100.00 | $169.82 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $338.84 / $707.95
| Professional | TC | $208.93 | $338.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $302.00 / $316.23
| Professional | | $251.19 | $302.00 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $169.82 / $169.82
| Professional | 26 | $102.33 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $407.38 / $524.81
| Professional | | $354.81 | $407.38 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $134.90 / $173.78
| Professional | 26 | $117.49 | $134.90 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $275.42 / $346.74
| Professional | TC | $239.88 | $275.42 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $257.04 / $467.74
| Professional | | $120.23 | $257.04 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $123.03 / $177.83
| Facility | 26 | $26.30 | $123.03 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $676.08 / $1,584.89
| Professional | | $309.03 | $676.08 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $144.54 / $245.47
| Professional | 26 | $95.50 | $144.54 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $457.09 / $1,380.38
| Professional | TC | $213.80 | $457.09 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $602.56 / $645.65
| Professional | | $549.54 | $602.56 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $204.17 / $263.03
| Professional | 26 | $138.04 | $204.17 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $389.05 / $602.56
| Professional | TC | $354.81 | $389.05 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $549.54 / $1,380.38
| Professional | | $323.59 | $549.54 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $138.04 / $234.42
| Professional | 26 | $102.33 | $138.04 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $363.08 / $1,096.48
| Professional | TC | $218.78 | $363.08 | $1,096.48 |