- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $190.55 / $346.74 / $549.54
| Facility | 26 | $190.55 | $346.74 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $812.83
| Professional | | $302.00 | $426.58 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $77.62 / $169.82
| Professional | 26 | $61.66 | $77.62 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $363.08 / $794.33
| Professional | TC | $245.47 | $363.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $239.88
| Professional | 26 | $85.11 | $85.11 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $549.54 / $933.25
| Professional | | $316.23 | $549.54 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $95.50 / $158.49
| Professional | 26 | $54.95 | $95.50 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $457.09 / $776.25
| Professional | TC | $263.03 | $457.09 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Professional | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | 26 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Professional | TC | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $467.74 / $794.33
| Professional | | $398.11 | $467.74 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $74.13 / $123.03
| Professional | 26 | $63.10 | $74.13 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $398.11 / $660.69
| Professional | TC | $338.84 | $398.11 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $501.19 / $870.96
| Professional | | $331.13 | $501.19 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $87.10 / $151.36
| Professional | 26 | $63.10 | $87.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $407.38 / $707.95
| Professional | TC | $275.42 | $407.38 | $707.95 |