- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | 26 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $467.74 / $2,187.76
| Professional | | $190.55 | $467.74 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $199.53 / $524.81
| Professional | 26 | $100.00 | $199.53 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $346.74 / $851.14
| Professional | TC | $257.04 | $346.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $630.96 / $1,230.27
| Professional | | $331.13 | $630.96 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $125.89 / $213.80
| Professional | 26 | $91.20 | $125.89 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $446.68 / $1,023.29
| Professional | TC | $229.09 | $446.68 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $691.83
| Professional | | $32.36 | $33.11 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Facility | 26 | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $575.44 / $1,071.52
| Professional | | $489.78 | $575.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $165.96 / $239.88
| Professional | 26 | $141.25 | $165.96 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $416.87 / $831.76
| Professional | TC | $346.74 | $416.87 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $537.03 / $1,148.15
| Professional | | $316.23 | $537.03 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $234.42 / $501.19
| Professional | 26 | $97.72 | $234.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $302.00 / $478.63
| Professional | TC | $223.87 | $302.00 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $380.19 / $645.65
| Professional | | $144.54 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $1,122.02
| Professional | | $338.84 | $501.19 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $93.33 / $181.97
| Professional | 26 | $87.10 | $93.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $380.19 / $933.25
| Professional | TC | $245.47 | $380.19 | $933.25 |