- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Facility | 26 | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $501.19 / $1,071.52
| Professional | | $389.05 | $501.19 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $234.42 / $524.81
| Professional | 26 | $186.21 | $234.42 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $269.15 / $562.34
| Professional | TC | $199.53 | $269.15 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $660.69 / $891.25
| Professional | | $478.63 | $660.69 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $316.23 / $363.08
| Professional | 26 | $223.87 | $316.23 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $338.84 / $398.11
| Professional | TC | $251.19 | $338.84 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $691.83 / $1,122.02
| Professional | | $562.34 | $691.83 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $338.84 / $549.54
| Professional | 26 | $275.42 | $338.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $354.81 / $575.44
| Professional | TC | $288.40 | $354.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $707.95 / $1,380.38
| Professional | | $588.84 | $707.95 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $281.84 / $338.84 / $645.65
| Professional | 26 | $281.84 | $338.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $371.54 / $724.44
| Professional | TC | $316.23 | $371.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $512.86 / $1,148.15
| Professional | | $426.58 | $512.86 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $190.55 / $251.19 / $524.81
| Professional | 26 | $190.55 | $251.19 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $275.42 / $616.60
| Professional | TC | $229.09 | $275.42 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $724.44 / $1,348.96
| Professional | | $562.34 | $724.44 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $281.84 / $323.59 / $588.84
| Professional | 26 | $281.84 | $323.59 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $389.05 / $676.08
| Professional | TC | $316.23 | $389.05 | $676.08 |