- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $288.40 / $346.74
| Facility | 26 | $123.03 | $288.40 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $446.68 / $2,137.96
| Professional | | $302.00 | $446.68 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $85.11 / $245.47
| Professional | 26 | $61.66 | $85.11 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $363.08 / $794.33
| Professional | TC | $245.47 | $363.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $891.25 / $1,202.26
| Professional | | $389.05 | $891.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $173.78 / $234.42
| Professional | 26 | $69.18 | $173.78 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $707.95 / $954.99
| Professional | TC | $316.23 | $707.95 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $676.08 / $933.25
| Professional | | $537.03 | $676.08 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $109.65 / $169.82
| Professional | 26 | $91.20 | $109.65 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $562.34 / $776.25
| Professional | TC | $446.68 | $562.34 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $100.00 / $549.54
| Professional | | $72.44 | $100.00 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $85.11 / $95.50
| Professional | 26 | $72.44 | $85.11 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $457.09
| Professional | TC | $380.19 | $380.19 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $104.71
| Professional | | $102.33 | $102.33 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $616.60 / $1,174.90
| Professional | | $331.13 | $616.60 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $107.15 / $199.53
| Professional | 26 | $66.07 | $107.15 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $478.63 / $977.24
| Professional | TC | $275.42 | $478.63 | $977.24 |