- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $245.47 / $416.87
| Facility | 26 | $128.82 | $245.47 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $602.56 / $2,187.76
| Professional | | $398.11 | $602.56 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $151.36 / $331.13
| Professional | 26 | $107.15 | $151.36 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $416.87 / $891.25
| Professional | TC | $281.84 | $416.87 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Professional | 26 | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,096.48 / $1,584.89
| Professional | | $457.09 | $1,096.48 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $245.47 / $346.74
| Professional | 26 | $104.71 | $245.47 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $851.14 / $1,230.27
| Professional | TC | $354.81 | $851.14 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,047.13 / $2,137.96
| Professional | | $575.44 | $1,047.13 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $186.21 / $323.59
| Professional | 26 | $117.49 | $186.21 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $831.76 / $1,819.70
| Professional | TC | $426.58 | $831.76 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $851.14 / $1,318.26
| Professional | | $549.54 | $851.14 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $186.21 / $288.40
| Professional | 26 | $120.23 | $186.21 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $660.69 / $1,023.29
| Professional | TC | $426.58 | $660.69 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $933.25 / $1,698.24
| Professional | | $562.34 | $933.25 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $169.82 / $338.84
| Professional | 26 | $114.82 | $169.82 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $724.44 / $1,288.25
| Professional | TC | $436.52 | $724.44 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $87.10 / $107.15
| Facility | 26 | $79.43 | $87.10 | $107.15 |