- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $87.10 / $138.04
| Facility | 26 | $83.18 | $87.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $776.25
| Professional | | $316.23 | $457.09 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $125.89 / $218.78
| Professional | 26 | $81.28 | $125.89 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $331.13 / $562.34
| Professional | TC | $229.09 | $331.13 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $707.95 / $794.33
| Professional | | $562.34 | $707.95 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $186.21 / $208.93
| Professional | 26 | $147.91 | $186.21 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $407.38 / $524.81 / $575.44
| Professional | TC | $407.38 | $524.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $602.56 / $977.24
| Professional | | $389.05 | $602.56 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $131.83 / $208.93
| Professional | 26 | $83.18 | $131.83 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $436.52 / $776.25
| Professional | TC | $281.84 | $436.52 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Facility | 26 | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $776.25 / $3,388.44
| Professional | | $354.81 | $776.25 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $158.49 / $660.69
| Professional | 26 | $85.11 | $158.49 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $616.60 / $2,951.21
| Professional | TC | $269.15 | $616.60 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $676.08 / $912.01
| Professional | | $354.81 | $676.08 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $147.91 / $218.78
| Professional | 26 | $75.86 | $147.91 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $524.81 / $741.31
| Professional | TC | $269.15 | $524.81 | $741.31 |