- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $177.83
| Facility | 26 | $112.20 | $162.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $478.63 / $1,122.02
| Professional | | $234.42 | $478.63 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $147.91 / $331.13
| Professional | 26 | $93.33 | $147.91 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $380.19 / $758.58
| Professional | TC | $281.84 | $380.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $537.03 / $676.08
| Professional | | $467.74 | $537.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $125.89 / $162.18
| Professional | 26 | $109.65 | $125.89 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $407.38 / $524.81
| Professional | TC | $354.81 | $407.38 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $117.49 / $165.96
| Facility | 26 | $25.12 | $117.49 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $741.31 / $1,258.93
| Professional | | $398.11 | $741.31 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $134.90 / $229.09
| Professional | 26 | $91.20 | $134.90 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $549.54 / $1,122.02
| Professional | TC | $309.03 | $549.54 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $724.44
| Professional | | $707.95 | $707.95 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $194.98 / $239.88
| Professional | 26 | $87.10 | $194.98 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $707.95 / $1,318.26
| Professional | | $426.58 | $707.95 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $120.23 / $218.78
| Professional | 26 | $93.33 | $120.23 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $524.81 / $1,071.52
| Professional | TC | $323.59 | $524.81 | $1,071.52 |