- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $162.18
| Facility | 26 | $128.82 | $128.82 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $537.03 / $1,548.82
| Professional | | $323.59 | $537.03 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $169.82 / $575.44
| Professional | 26 | $100.00 | $169.82 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $302.00 / $562.34
| Professional | TC | $213.80 | $302.00 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $263.03 / $588.84
| Professional | | $257.04 | $263.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $114.82 / $190.55
| Professional | 26 | $85.11 | $114.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $512.86 / $549.54
| Professional | | $389.05 | $512.86 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Professional | 26 | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $281.84 / $478.63
| Professional | | $120.23 | $281.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $501.19 / $954.99
| Professional | | $316.23 | $501.19 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $144.54 / $281.84
| Professional | 26 | $85.11 | $144.54 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $346.74 / $707.95
| Professional | TC | $229.09 | $346.74 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $131.83 / $245.47
| Facility | 26 | $128.82 | $131.83 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $1,023.29
| Professional | | $316.23 | $478.63 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $141.25 / $407.38
| Professional | 26 | $97.72 | $141.25 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $295.12 / $602.56
| Professional | TC | $218.78 | $295.12 | $602.56 |
- 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
- $91.20 / $128.82 / $199.53
| Professional | 26 | $91.20 | $128.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $295.12 / $501.19
| Professional | TC | $229.09 | $295.12 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $602.56 / $1,698.24
| Professional | | $309.03 | $602.56 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $114.82 / $645.65
| Professional | 26 | $79.43 | $114.82 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $446.68 / $1,174.90
| Professional | TC | $147.91 | $446.68 | $1,174.90 |