- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $204.17 / $851.14 / $1,445.44
| Facility | 26 | $204.17 | $851.14 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $3,890.45
| Professional | | $354.81 | $512.86 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $190.55 / $316.23 / $660.69
| Professional | 26 | $190.55 | $316.23 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $295.12 / $741.31
| Professional | TC | $186.21 | $295.12 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $3,715.35 / $5,128.61
| Professional | | $549.54 | $3,715.35 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $288.40
| Professional | 26 | $245.47 | $245.47 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Professional | TC | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $870.96 / $2,187.76
| Professional | | $436.52 | $870.96 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $331.13 / $831.76
| Professional | 26 | $194.98 | $331.13 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $660.69 / $1,230.27
| Professional | TC | $234.42 | $660.69 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $616.60 / $1,122.02
| Professional | | $524.81 | $616.60 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $275.42 / $501.19
| Professional | 26 | $234.42 | $275.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $338.84 / $616.60
| Professional | TC | $295.12 | $338.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,122.02 / $3,981.07
| Professional | | $478.63 | $1,122.02 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $309.03 / $1,288.25
| Professional | 26 | $177.83 | $309.03 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $645.65 / $2,754.23
| Professional | TC | $269.15 | $645.65 | $2,754.23 |