- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $288.40 / $691.83
| Facility | 26 | $117.49 | $288.40 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $2,454.71
| Professional | | $338.84 | $501.19 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $229.09 / $380.19
| Professional | 26 | $107.15 | $229.09 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $338.84 / $912.01
| Professional | TC | $223.87 | $338.84 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $426.58 / $3,715.35
| Professional | | $151.36 | $426.58 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $134.90 / $134.90
| Professional | 26 | $120.23 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $295.12 / $512.86
| Professional | TC | $288.40 | $295.12 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $758.58 / $1,513.56
| Professional | | $316.23 | $758.58 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $141.25 / $309.03
| Professional | 26 | $85.11 | $141.25 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $489.78 / $1,122.02
| Professional | TC | $223.87 | $489.78 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $363.08 / $776.25
| Professional | | $309.03 | $363.08 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $114.82 / $239.88
| Professional | 26 | $97.72 | $114.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $251.19 / $549.54
| Professional | TC | $213.80 | $251.19 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $446.68 / $3,235.94
| Professional | | $95.50 | $446.68 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $229.09 / $758.58
| Professional | 26 | $95.50 | $229.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $389.05 / $1,445.44
| Professional | TC | $229.09 | $389.05 | $1,445.44 |