- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Facility | 26 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $288.40 / $630.96
| Professional | | $234.42 | $288.40 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $169.82 / $331.13
| Professional | 26 | $144.54 | $169.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $104.71 / $169.82
| Professional | TC | $85.11 | $104.71 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $138.04 / $138.04
| Facility | 26 | $114.82 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $602.56 / $870.96
| Professional | | $354.81 | $602.56 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $389.05 / $549.54
| Professional | 26 | $223.87 | $389.05 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $234.42 / $316.23
| Professional | TC | $128.82 | $234.42 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $575.44 / $1,380.38
| Facility | 26 | $407.38 | $575.44 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $660.69 / $1,047.13
| Professional | | $407.38 | $660.69 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $660.69
| Professional | 26 | $251.19 | $416.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $245.47 / $389.05
| Professional | TC | $154.88 | $245.47 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $549.54 / $1,071.52
| Facility | 26 | $446.68 | $549.54 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $616.60 / $933.25
| Professional | | $436.52 | $616.60 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $389.05 / $588.84
| Professional | 26 | $275.42 | $389.05 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $229.09 / $346.74
| Professional | TC | $162.18 | $229.09 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $562.34 / $1,584.89
| Professional | | $269.15 | $562.34 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $302.00 / $977.24
| Professional | 26 | $162.18 | $302.00 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $194.98 / $616.60
| Professional | TC | $104.71 | $194.98 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $512.86 / $912.01
| Professional | | $269.15 | $512.86 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $316.23 / $562.34
| Professional | 26 | $162.18 | $316.23 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $199.53 / $346.74
| Professional | TC | $104.71 | $199.53 | $346.74 |