- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $676.08
| Facility | 26 | $93.33 | $93.33 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $457.09 / $1,318.26
| Professional | | $309.03 | $457.09 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $131.83 / $316.23
| Professional | 26 | $77.62 | $131.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $346.74 / $691.83
| Professional | TC | $234.42 | $346.74 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $549.54
| Professional | | $457.09 | $457.09 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $134.90
| Professional | 26 | $112.20 | $112.20 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $407.38
| Professional | TC | $346.74 | $346.74 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $691.83 / $1,698.24
| Professional | | $363.08 | $691.83 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $154.88 / $389.05
| Professional | 26 | $91.20 | $154.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $537.03 / $1,318.26
| Professional | TC | $275.42 | $537.03 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $512.86 / $977.24
| Professional | | $446.68 | $512.86 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $125.89 / $234.42
| Professional | 26 | $109.65 | $125.89 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $389.05 / $758.58
| Professional | TC | $338.84 | $389.05 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $660.69 / $1,380.38
| Professional | | $371.54 | $660.69 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $144.54 / $331.13
| Professional | 26 | $85.11 | $144.54 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $512.86 / $1,047.13
| Professional | TC | $281.84 | $512.86 | $1,047.13 |