- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | 26 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $524.81 / $2,187.76
| Professional | | $363.08 | $524.81 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $154.88 / $323.59
| Professional | 26 | $83.18 | $154.88 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $363.08 / $794.33
| Professional | TC | $275.42 | $363.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $549.54 / $776.25
| Professional | | $323.59 | $549.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $181.97
| Professional | 26 | $75.86 | $104.71 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $416.87 / $660.69
| Professional | TC | $245.47 | $416.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $549.54
| Professional | | $32.36 | $33.11 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $575.44 / $891.25
| Professional | | $489.78 | $575.44 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $138.04 / $199.53
| Professional | 26 | $117.49 | $138.04 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $436.52 / $676.08
| Professional | TC | $371.54 | $436.52 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $524.81 / $933.25
| Professional | | $316.23 | $524.81 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $194.98 / $371.54
| Professional | 26 | $81.28 | $194.98 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $323.59 / $512.86
| Professional | TC | $239.88 | $323.59 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $398.11 / $616.60
| Professional | | $120.23 | $398.11 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $446.68 / $707.95
| Professional | | $331.13 | $446.68 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $77.62 / $151.36
| Professional | 26 | $74.13 | $77.62 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $331.13 / $616.60
| Professional | TC | $257.04 | $331.13 | $616.60 |