- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $190.55
| Facility | 26 | $123.03 | $123.03 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $229.09 / $512.86
| Professional | | $194.98 | $229.09 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $131.83 / $295.12
| Professional | 26 | $117.49 | $131.83 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $87.10 / $144.54
| Professional | TC | $74.13 | $87.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $239.88 / $288.40
| Professional | | $204.17 | $239.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Professional | 26 | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $213.80 / $295.12
| Professional | | $128.82 | $213.80 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $295.12 / $346.74
| Professional | | $218.78 | $295.12 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $177.83 / $218.78
| Professional | 26 | $128.82 | $177.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $114.82 / $138.04
| Professional | TC | $79.43 | $114.82 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $588.84 / $588.84
| Facility | 26 | $302.00 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $257.04 / $1,380.38
| Professional | | $194.98 | $257.04 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $831.76
| Professional | 26 | $114.82 | $151.36 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $109.65 / $549.54
| Professional | TC | $79.43 | $109.65 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $245.47 / $371.54
| Professional | | $186.21 | $245.47 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $144.54 / $218.78
| Professional | 26 | $109.65 | $144.54 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $102.33 / $147.91
| Professional | TC | $77.62 | $102.33 | $147.91 |