- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $107.15 / $239.88
| Facility | 26 | $70.79 | $107.15 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $457.09 / $1,445.44
| Professional | | $275.42 | $457.09 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $125.89 / $257.04
| Professional | 26 | $70.79 | $125.89 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $338.84 / $741.31
| Professional | TC | $204.17 | $338.84 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $93.33 / $173.78
| Professional | 26 | $70.79 | $93.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Professional | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $213.80
| Professional | 26 | $112.20 | $173.78 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $616.60 / $812.83
| Professional | TC | $446.68 | $616.60 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $588.84 / $954.99
| Professional | | $309.03 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $107.15 / $199.53
| Professional | 26 | $60.26 | $107.15 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $457.09 / $794.33
| Professional | TC | $234.42 | $457.09 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Professional | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Professional | 26 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $741.31 / $1,288.25
| Professional | | $562.34 | $741.31 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $457.09 / $812.83
| Professional | | $269.15 | $457.09 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $89.13 / $199.53
| Professional | 26 | $66.07 | $89.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $363.08 / $616.60
| Professional | TC | $213.80 | $363.08 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | 26 | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $2,951.21
| Professional | | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $562.34
| Professional | 26 | $549.54 | $549.54 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,570.40 / $2,570.40 / $2,570.40
| Professional | TC | $2,570.40 | $2,570.40 | $2,570.40 |