- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Facility | 26 | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $691.83
| Professional | | $316.23 | $457.09 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $123.03 / $181.97
| Professional | 26 | $83.18 | $123.03 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $331.13 / $537.03
| Professional | TC | $229.09 | $331.13 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Professional | 26 | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $724.44 / $1,023.29
| Professional | | $302.00 | $724.44 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $186.21 / $263.03
| Professional | 26 | $79.43 | $186.21 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $512.86 / $758.58
| Professional | TC | $218.78 | $512.86 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $707.95 / $1,513.56
| Professional | | $398.11 | $707.95 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $154.88 / $245.47
| Professional | 26 | $91.20 | $154.88 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $524.81 / $1,288.25
| Professional | TC | $302.00 | $524.81 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $562.34 / $851.14
| Professional | | $354.81 | $562.34 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $144.54 / $223.87
| Professional | 26 | $91.20 | $144.54 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $407.38 / $630.96
| Professional | TC | $257.04 | $407.38 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $602.56 / $1,148.15
| Professional | | $363.08 | $602.56 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $125.89 / $239.88
| Professional | 26 | $87.10 | $125.89 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $436.52 / $812.83
| Professional | TC | $269.15 | $436.52 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $67.61 / $81.28
| Facility | 26 | $61.66 | $67.61 | $81.28 |