- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $112.20 / $151.36
| Facility | 26 | $87.10 | $112.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $398.11 / $1,258.93
| Professional | | $288.40 | $398.11 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $91.20 / $251.19
| Professional | 26 | $79.43 | $91.20 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $281.84 / $478.63
| Professional | TC | $213.80 | $281.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $275.42 / $489.78
| Professional | | $223.87 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $134.90
| Professional | 26 | $64.57 | $79.43 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $199.53 / $467.74
| Professional | TC | $169.82 | $199.53 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $602.56 / $912.01
| Professional | | $275.42 | $602.56 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $158.49 / $234.42
| Professional | 26 | $85.11 | $158.49 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $446.68 / $676.08
| Professional | TC | $190.55 | $446.68 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $245.47 / $380.19
| Professional | | $89.13 | $245.47 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $416.87 / $660.69
| Professional | | $288.40 | $416.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $112.20 / $190.55
| Professional | 26 | $74.13 | $112.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $295.12 / $489.78
| Professional | TC | $204.17 | $295.12 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $354.81 / $676.08
| Professional | | $281.84 | $354.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $97.72 / $186.21
| Professional | 26 | $79.43 | $97.72 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $257.04 / $478.63
| Professional | TC | $204.17 | $257.04 | $478.63 |