- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | 26 | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $295.12 / $831.76
| Professional | | $213.80 | $295.12 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $181.97 / $478.63
| Professional | 26 | $114.82 | $181.97 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $346.74
| Professional | TC | $97.72 | $144.54 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $912.01
| Professional | | $776.25 | $776.25 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $537.03
| Professional | 26 | $457.09 | $457.09 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $389.05
| Professional | TC | $316.23 | $316.23 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | 26 | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $724.44 / $933.25
| Professional | | $295.12 | $724.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $380.19 / $537.03
| Professional | 26 | $151.36 | $380.19 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $346.74 / $446.68
| Professional | TC | $144.54 | $346.74 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,174.90 / $2,511.89
| Professional | | $1,174.90 | $1,174.90 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $562.34 / $616.60 / $1,318.26
| Professional | 26 | $562.34 | $616.60 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $549.54 / $1,202.26
| Professional | TC | $512.86 | $549.54 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $575.44 / $912.01
| Professional | | $275.42 | $575.44 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $204.17 / $537.03
| Professional | 26 | $144.54 | $204.17 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $186.21 / $389.05
| Professional | TC | $128.82 | $186.21 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $1,096.48 / $4,168.69
| Professional | | $426.58 | $1,096.48 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $645.65 / $2,454.71
| Professional | 26 | $223.87 | $645.65 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $457.09 / $1,778.28
| Professional | TC | $199.53 | $457.09 | $1,778.28 |