- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $186.21
| Facility | 26 | $177.83 | $177.83 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $436.52 / $870.96
| Professional | | $316.23 | $436.52 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $154.88 / $398.11
| Professional | 26 | $128.82 | $154.88 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $281.84 / $512.86
| Professional | TC | $186.21 | $281.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Professional | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $691.83 / $741.31
| Professional | | $467.74 | $691.83 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Professional | 26 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $416.87 / $724.44
| Professional | | $316.23 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $190.55 / $288.40
| Professional | 26 | $128.82 | $190.55 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $288.40 / $426.58
| Professional | TC | $186.21 | $288.40 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $186.21 / $331.13
| Facility | 26 | $120.23 | $186.21 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $436.52 / $776.25
| Professional | | $263.03 | $436.52 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $281.84
| Professional | 26 | $112.20 | $162.18 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $512.86
| Professional | TC | $151.36 | $281.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $724.44
| Professional | | $316.23 | $457.09 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $245.47 / $309.03
| Professional | 26 | $131.83 | $245.47 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $295.12 / $660.69
| Professional | TC | $186.21 | $295.12 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $426.58 / $575.44
| Professional | | $331.13 | $426.58 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $177.83 / $257.04
| Professional | 26 | $138.04 | $177.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $263.03 / $354.81
| Professional | TC | $190.55 | $263.03 | $354.81 |