- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $524.81 / $1,445.44
| Professional | | $257.04 | $524.81 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $125.89 / $323.59
| Professional | 26 | $67.61 | $125.89 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $338.84 / $616.60
| Professional | TC | $186.21 | $338.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $467.74
| Professional | | $107.15 | $107.15 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $134.90
| Facility | 26 | $107.15 | $107.15 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $512.86 / $758.58
| Professional | | $371.54 | $512.86 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $107.15 / $194.98
| Professional | 26 | $47.86 | $107.15 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $398.11 / $660.69
| Professional | TC | $173.78 | $398.11 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $436.52 / $758.58
| Professional | | $407.38 | $436.52 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $134.90
| Facility | 26 | $107.15 | $107.15 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $562.34 / $645.65
| Professional | | $371.54 | $562.34 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $107.15 / $158.49
| Professional | 26 | $70.79 | $107.15 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $316.23 / $489.78
| Professional | TC | $181.97 | $316.23 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $407.38 / $630.96
| Professional | | $229.09 | $407.38 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $64.57 / $158.49
| Professional | 26 | $63.10 | $64.57 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $309.03 / $537.03
| Professional | TC | $165.96 | $309.03 | $537.03 |