- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $288.40 / $645.65
| Facility | 26 | $117.49 | $288.40 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $426.58 / $1,148.15
| Professional | | $208.93 | $426.58 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $213.80 / $446.68
| Professional | 26 | $102.33 | $213.80 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $338.84 / $954.99
| Professional | TC | $245.47 | $338.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $501.19 / $3,981.07
| Professional | | $125.89 | $501.19 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $141.25
| Professional | 26 | $125.89 | $125.89 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $363.08 / $537.03
| Professional | TC | $323.59 | $363.08 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $794.33 / $1,412.54
| Professional | | $407.38 | $794.33 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $123.03 / $288.40
| Professional | 26 | $79.43 | $123.03 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $575.44 / $1,202.26
| Professional | TC | $323.59 | $575.44 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $389.05 / $831.76
| Professional | | $331.13 | $389.05 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $107.15 / $223.87
| Professional | 26 | $91.20 | $107.15 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $275.42 / $616.60
| Professional | TC | $234.42 | $275.42 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $467.74 / $2,344.23
| Professional | | $95.50 | $467.74 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $169.82 / $630.96
| Professional | 26 | $95.50 | $169.82 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $338.84 / $1,698.24
| Professional | TC | $95.50 | $338.84 | $1,698.24 |