- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $36.31 / $58.88
| Facility | 26 | $34.67 | $36.31 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $323.59 / $501.19
| Professional | | $223.87 | $323.59 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $56.23 / $95.50
| Professional | 26 | $30.90 | $56.23 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $288.40 / $446.68
| Professional | TC | $204.17 | $288.40 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $660.69 / $741.31
| Professional | | $501.19 | $660.69 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $89.13
| Professional | 26 | $60.26 | $79.43 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $588.84 / $660.69
| Professional | TC | $446.68 | $588.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $562.34 / $741.31
| Professional | | $407.38 | $562.34 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $64.57 / $85.11
| Professional | 26 | $43.65 | $64.57 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $501.19 / $660.69
| Professional | TC | $363.08 | $501.19 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $645.65 / $1,995.26
| Professional | | $338.84 | $645.65 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $69.18 / $218.78
| Professional | 26 | $37.15 | $69.18 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $575.44 / $1,778.28
| Professional | TC | $302.00 | $575.44 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $602.56 / $831.76
| Professional | | $295.12 | $602.56 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $66.07 / $93.33
| Professional | 26 | $33.11 | $66.07 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $524.81 / $724.44
| Professional | TC | $263.03 | $524.81 | $724.44 |