- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $269.15
| Facility | 26 | $154.88 | $154.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $457.09 / $724.44
| Professional | | $346.74 | $457.09 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $154.88 / $389.05
| Professional | 26 | $131.83 | $154.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $269.15 / $478.63
| Professional | TC | $208.93 | $269.15 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $977.24 / $1,174.90
| Professional | | $812.83 | $977.24 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $323.59 / $389.05
| Professional | 26 | $269.15 | $323.59 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $537.03 / $660.69 / $794.33
| Professional | TC | $537.03 | $660.69 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $724.44 / $1,122.02
| Professional | | $416.87 | $724.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $257.04 / $363.08
| Professional | 26 | $165.96 | $257.04 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $478.63 / $758.58
| Professional | TC | $269.15 | $478.63 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $707.95 / $2,884.03
| Professional | | $398.11 | $707.95 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $281.84 / $954.99
| Professional | 26 | $158.49 | $281.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $416.87 / $1,905.46
| Professional | TC | $234.42 | $416.87 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $724.44 / $1,071.52
| Professional | | $389.05 | $724.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $398.11
| Professional | 26 | $151.36 | $281.84 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $416.87 / $691.83
| Professional | TC | $223.87 | $416.87 | $691.83 |