- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $162.18 / $281.84
| Facility | 26 | $117.49 | $162.18 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $478.63 / $1,023.29
| Professional | | $331.13 | $478.63 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $125.89 / $245.47
| Professional | 26 | $69.18 | $125.89 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $363.08 / $794.33
| Professional | TC | $251.19 | $363.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $457.09 / $758.58
| Professional | | $323.59 | $457.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $91.20 / $144.54
| Professional | 26 | $66.07 | $91.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $602.56
| Professional | TC | $257.04 | $363.08 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $489.78 / $2,951.21
| Professional | | $102.33 | $489.78 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $95.50 / $144.54
| Professional | 26 | $87.10 | $95.50 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $446.68 / $616.60
| Professional | TC | $363.08 | $446.68 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | 26 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $707.95 / $1,288.25
| Professional | | $302.00 | $707.95 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $97.72 / $181.97
| Professional | 26 | $56.23 | $97.72 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $562.34 / $1,148.15
| Professional | TC | $239.88 | $562.34 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $389.05 / $512.86
| Professional | | $323.59 | $389.05 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $77.62 / $97.72
| Professional | 26 | $63.10 | $77.62 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $309.03 / $416.87
| Professional | TC | $257.04 | $309.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,412.54 / $1,445.44
| Professional | | $794.33 | $1,412.54 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $151.36 / $158.49
| Professional | 26 | $125.89 | $151.36 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $758.58
| Professional | | $562.34 | $562.34 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $562.34 / $2,089.30
| Professional | | $104.71 | $562.34 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $107.15 / $173.78
| Professional | 26 | $74.13 | $107.15 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $549.54 / $912.01
| Professional | TC | $295.12 | $549.54 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $575.44 / $1,412.54
| Professional | | $302.00 | $575.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $91.20 / $158.49
| Professional | 26 | $53.70 | $91.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $478.63 / $1,202.26
| Professional | TC | $239.88 | $478.63 | $1,202.26 |