- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $154.88 / $169.82
| Facility | 26 | $128.82 | $154.88 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $1,698.24
| Professional | | $302.00 | $426.58 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $107.15 / $316.23
| Professional | 26 | $81.28 | $107.15 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $302.00 / $616.60
| Professional | TC | $223.87 | $302.00 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Professional | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $257.04
| Professional | TC | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $239.88 / $426.58
| Professional | | $67.61 | $239.88 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $537.03 / $794.33
| Professional | | $331.13 | $537.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $181.97
| Professional | 26 | $79.43 | $125.89 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $389.05 / $602.56
| Professional | TC | $239.88 | $389.05 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $398.11
| Professional | | $32.36 | $33.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $616.60 / $912.01
| Professional | | $331.13 | $616.60 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $181.97
| Professional | 26 | $85.11 | $128.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $380.19 / $549.54
| Professional | TC | $251.19 | $380.19 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $407.38 / $831.76
| Professional | | $316.23 | $407.38 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $93.33 / $223.87
| Professional | 26 | $83.18 | $93.33 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $316.23 / $602.56
| Professional | TC | $229.09 | $316.23 | $602.56 |