- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $275.42 / $537.03
| Facility | 26 | $117.49 | $275.42 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $501.19 / $2,187.76
| Professional | | $354.81 | $501.19 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $154.88 / $275.42
| Professional | 26 | $85.11 | $154.88 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $363.08 / $870.96
| Professional | TC | $263.03 | $363.08 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $467.74 / $3,715.35
| Professional | | $104.71 | $467.74 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $117.49 / $117.49
| Professional | 26 | $93.33 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $363.08 / $478.63
| Professional | TC | $354.81 | $363.08 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $912.01 / $1,659.59
| Professional | | $467.74 | $912.01 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $102.33 / $239.88
| Professional | 26 | $67.61 | $102.33 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $724.44 / $1,479.11
| Professional | TC | $371.54 | $724.44 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $398.11 / $891.25
| Professional | | $338.84 | $398.11 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $89.13 / $186.21
| Professional | 26 | $75.86 | $89.13 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $309.03 / $724.44
| Professional | TC | $263.03 | $309.03 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $467.74 / $3,548.13
| Professional | | $95.50 | $467.74 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $295.12 / $537.03
| Professional | 26 | $79.43 | $295.12 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $478.63 / $1,778.28
| Professional | TC | $275.42 | $478.63 | $1,778.28 |