- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $109.65 / $177.83
| Facility | 26 | $107.15 | $109.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $1,380.38
| Professional | | $354.81 | $512.86 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $190.55 / $331.13
| Professional | 26 | $97.72 | $190.55 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $363.08 / $1,584.89
| Professional | TC | $245.47 | $363.08 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $794.33 / $891.25
| Professional | | $602.56 | $794.33 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $239.88 / $269.15
| Professional | 26 | $181.97 | $239.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $549.54 / $616.60
| Professional | TC | $416.87 | $549.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $676.08 / $1,230.27
| Professional | | $426.58 | $676.08 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $169.82 / $269.15
| Professional | 26 | $109.65 | $169.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $467.74 / $1,096.48
| Professional | TC | $302.00 | $467.74 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $977.24
| Facility | 26 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $891.25 / $6,025.60
| Professional | | $398.11 | $891.25 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $223.87 / $891.25
| Professional | 26 | $112.20 | $223.87 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $676.08 / $5,495.41
| Professional | TC | $288.40 | $676.08 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $616.60 / $1,023.29
| Professional | | $100.00 | $616.60 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $181.97 / $281.84
| Professional | 26 | $100.00 | $181.97 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $602.56 / $933.25
| Professional | TC | $288.40 | $602.56 | $933.25 |