- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $251.19 / $338.84
| Facility | 26 | $239.88 | $251.19 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $478.63 / $1,380.38
| Professional | | $338.84 | $478.63 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $134.90 / $316.23
| Professional | 26 | $70.79 | $134.90 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $363.08 / $870.96
| Professional | TC | $263.03 | $363.08 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Professional | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $53.70 / $72.44
| Professional | 26 | $51.29 | $53.70 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $478.63 / $776.25
| Professional | | $389.05 | $478.63 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $87.10 / $138.04
| Professional | 26 | $69.18 | $87.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $398.11 / $630.96
| Professional | TC | $316.23 | $398.11 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $79.43 / $114.82
| Facility | 26 | $16.98 | $79.43 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $602.56 / $1,230.27
| Professional | | $281.84 | $602.56 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $93.33 / $162.18
| Professional | 26 | $56.23 | $93.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $489.78 / $1,047.13
| Professional | TC | $223.87 | $489.78 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $512.86 / $660.69 / $660.69
| Facility | 26 | $512.86 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $794.33 / $5,370.32
| Professional | | $323.59 | $794.33 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $87.10 / $812.83
| Professional | 26 | $64.57 | $87.10 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $676.08 / $4,897.79
| Professional | TC | $257.04 | $676.08 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $537.03 / $1,122.02
| Professional | | $295.12 | $537.03 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $77.62 / $181.97
| Professional | 26 | $64.57 | $77.62 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $467.74 / $851.14
| Professional | TC | $257.04 | $467.74 | $851.14 |