- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $229.09
| Facility | 26 | $144.54 | $144.54 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $257.04 / $575.44
| Professional | | $218.78 | $257.04 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $154.88 / $309.03
| Professional | 26 | $141.25 | $154.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $97.72 / $154.88
| Professional | TC | $83.18 | $97.72 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $281.84 / $323.59
| Professional | | $239.88 | $281.84 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $245.47 / $338.84
| Professional | | $154.88 | $245.47 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $338.84 / $398.11
| Professional | | $251.19 | $338.84 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $208.93 / $263.03
| Professional | 26 | $151.36 | $208.93 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $125.89 / $151.36
| Professional | TC | $89.13 | $125.89 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $691.83 / $691.83
| Facility | 26 | $354.81 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $302.00 / $1,584.89
| Professional | | $223.87 | $302.00 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $181.97 / $977.24
| Professional | 26 | $134.90 | $181.97 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $117.49 / $616.60
| Professional | TC | $87.10 | $117.49 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $281.84 / $426.58
| Professional | | $213.80 | $281.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $173.78 / $263.03
| Professional | 26 | $131.83 | $173.78 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $109.65 / $165.96
| Professional | TC | $83.18 | $109.65 | $165.96 |