- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $251.19
| Facility | 26 | $128.82 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $891.25
| Professional | | $302.00 | $426.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $151.36 / $338.84
| Professional | 26 | $97.72 | $151.36 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $295.12 / $489.78
| Professional | TC | $208.93 | $295.12 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $134.90 / $346.74
| Professional | 26 | $123.03 | $134.90 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $812.83 / $1,174.90
| Professional | | $338.84 | $812.83 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $245.47 / $354.81
| Professional | 26 | $104.71 | $245.47 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $549.54 / $851.14
| Professional | TC | $234.42 | $549.54 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $660.69 / $1,148.15
| Professional | | $416.87 | $660.69 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $186.21 / $323.59
| Professional | 26 | $120.23 | $186.21 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $478.63 / $794.33
| Professional | TC | $288.40 | $478.63 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $616.60 / $977.24
| Professional | | $389.05 | $616.60 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $190.55 / $295.12
| Professional | 26 | $123.03 | $190.55 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $426.58 / $660.69
| Professional | TC | $275.42 | $426.58 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $707.95 / $1,380.38
| Professional | | $407.38 | $707.95 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $165.96 / $331.13
| Professional | 26 | $109.65 | $165.96 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $457.09 / $1,047.13
| Professional | TC | $281.84 | $457.09 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $89.13 / $104.71
| Facility | 26 | $81.28 | $89.13 | $104.71 |