- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $89.13 / $144.54
| Facility | 26 | $85.11 | $89.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $478.63 / $851.14
| Professional | | $346.74 | $478.63 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $131.83 / $213.80
| Professional | 26 | $85.11 | $131.83 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $630.96
| Professional | TC | $257.04 | $363.08 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $794.33 / $891.25
| Professional | | $630.96 | $794.33 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $218.78
| Professional | 26 | $154.88 | $194.98 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $602.56 / $660.69
| Professional | TC | $467.74 | $602.56 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $660.69 / $933.25
| Professional | | $426.58 | $660.69 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $138.04 / $218.78
| Professional | 26 | $87.10 | $138.04 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $501.19 / $758.58
| Professional | TC | $323.59 | $501.19 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | 26 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $724.44 / $3,019.95
| Professional | | $389.05 | $724.44 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $162.18 / $602.56
| Professional | 26 | $91.20 | $162.18 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $562.34 / $2,570.40
| Professional | TC | $302.00 | $562.34 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $588.84 / $933.25
| Professional | | $100.00 | $588.84 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $151.36 / $223.87
| Professional | 26 | $87.10 | $151.36 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $537.03 / $741.31
| Professional | TC | $302.00 | $537.03 | $741.31 |