- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $169.82 / $229.09
| Facility | 26 | $117.49 | $169.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $512.86 / $2,454.71
| Professional | | $346.74 | $512.86 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $213.80 / $537.03
| Professional | 26 | $117.49 | $213.80 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $338.84 / $707.95
| Professional | TC | $229.09 | $338.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $134.90 / $158.49
| Professional | 26 | $93.33 | $134.90 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $457.09 / $870.96
| Professional | | $426.58 | $457.09 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $141.25 / $239.88
| Professional | 26 | $128.82 | $141.25 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $302.00 / $602.56
| Professional | TC | $281.84 | $302.00 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $239.88 / $426.58
| Professional | | $125.89 | $239.88 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $138.04 / $199.53
| Facility | 26 | $30.20 | $138.04 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $758.58 / $2,691.53
| Professional | | $389.05 | $758.58 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $181.97 / $562.34
| Professional | 26 | $114.82 | $181.97 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $562.34 / $1,819.70
| Professional | TC | $269.15 | $562.34 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $371.54
| Professional | | $32.36 | $33.11 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $602.56 / $891.25
| Professional | | $371.54 | $602.56 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $131.83 / $223.87
| Professional | 26 | $112.20 | $131.83 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $467.74 / $630.96
| Professional | TC | $251.19 | $467.74 | $630.96 |