- 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
- $218.78 / $446.68 / $1,174.90
| Professional | | $218.78 | $446.68 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $165.96 / $416.87
| Professional | 26 | $95.50 | $165.96 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $338.84 / $575.44
| Professional | TC | $234.42 | $338.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Professional | 26 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $436.52 / $562.34
| Professional | | $380.19 | $436.52 | $562.34 |
- 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
- $269.15 / $309.03 / $398.11
| Professional | TC | $269.15 | $309.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $288.40 / $489.78
| Professional | | $112.20 | $288.40 | $489.78 |
- 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
- $346.74 / $707.95 / $1,258.93
| Professional | | $346.74 | $707.95 | $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
- $245.47 / $478.63 / $1,122.02
| Professional | TC | $245.47 | $478.63 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $724.44
| Professional | | $660.69 | $660.69 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $194.98 / $218.78
| Professional | 26 | $181.97 | $194.98 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $416.87 / $724.44
| Professional | TC | $398.11 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $645.65 / $1,230.27
| Professional | | $346.74 | $645.65 | $1,230.27 |
- 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
- $251.19 / $416.87 / $1,023.29
| Professional | TC | $251.19 | $416.87 | $1,023.29 |