- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $154.88 / $177.83
| Facility | 26 | $104.71 | $154.88 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $489.78 / $1,288.25
| Professional | | $269.15 | $489.78 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $125.89 / $263.03
| Professional | 26 | $72.44 | $125.89 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $309.03 / $549.54
| Professional | TC | $194.98 | $309.03 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $81.28 / $114.82
| Facility | 26 | $17.38 | $81.28 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $512.86 / $1,023.29
| Professional | | $263.03 | $512.86 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $208.93
| Professional | 26 | $58.88 | $93.33 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $398.11 / $794.33
| Professional | TC | $190.55 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $562.34 / $676.08
| Professional | | $489.78 | $562.34 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $151.36 / $181.97
| Professional | 26 | $131.83 | $151.36 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $398.11 / $501.19
| Professional | TC | $354.81 | $398.11 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $154.88 / $177.83
| Facility | 26 | $104.71 | $154.88 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $588.84 / $954.99
| Professional | | $416.87 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $147.91 / $218.78
| Professional | 26 | $107.15 | $147.91 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $724.44
| Professional | TC | $302.00 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $199.53 / $758.58
| Professional | | $87.10 | $199.53 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $630.96 / $977.24
| Professional | | $275.42 | $630.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $120.23 / $204.17
| Professional | 26 | $69.18 | $120.23 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $501.19 / $1,023.29
| Professional | TC | $190.55 | $501.19 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | 26 | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $616.60 / $812.83
| Professional | | $478.63 | $616.60 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $151.36 / $204.17
| Professional | 26 | $109.65 | $151.36 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $446.68 / $676.08
| Professional | TC | $346.74 | $446.68 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $467.74 / $954.99
| Professional | | $239.88 | $467.74 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $85.11 / $218.78
| Professional | 26 | $52.48 | $85.11 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $380.19 / $776.25
| Professional | TC | $173.78 | $380.19 | $776.25 |