- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | 26 | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $478.63
| Professional | | $204.17 | $269.15 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $120.23 / $194.98
| Professional | 26 | $85.11 | $120.23 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $275.42
| Professional | TC | $100.00 | $141.25 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $660.69 / $954.99
| Professional | | $218.78 | $660.69 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $177.83 / $257.04
| Professional | 26 | $109.65 | $177.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $478.63 / $707.95
| Professional | TC | $107.15 | $478.63 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $660.69 / $1,412.54
| Professional | | $426.58 | $660.69 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $169.82 / $338.84
| Professional | 26 | $112.20 | $169.82 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $489.78 / $1,071.52
| Professional | TC | $309.03 | $489.78 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $741.31 / $1,096.48
| Professional | | $478.63 | $741.31 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $199.53 / $295.12
| Professional | 26 | $128.82 | $199.53 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $537.03 / $794.33
| Professional | TC | $346.74 | $537.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $676.08 / $1,318.26
| Professional | | $446.68 | $676.08 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $177.83 / $346.74
| Professional | 26 | $123.03 | $177.83 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $501.19 / $977.24
| Professional | TC | $331.13 | $501.19 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $93.33 / $109.65
| Facility | 26 | $85.11 | $93.33 | $109.65 |