- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $263.03 / $812.83
| Facility | 26 | $186.21 | $263.03 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $446.68 / $1,513.56
| Professional | | $323.59 | $446.68 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $134.90 / $275.42
| Professional | 26 | $81.28 | $134.90 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $302.00 / $831.76
| Professional | TC | $245.47 | $302.00 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $630.96 / $676.08
| Professional | | $588.84 | $630.96 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $158.49 / $169.82
| Professional | 26 | $147.91 | $158.49 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $467.74 / $501.19
| Professional | TC | $446.68 | $467.74 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Facility | 26 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $794.33 / $1,023.29
| Professional | | $549.54 | $794.33 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $181.97 / $245.47
| Professional | 26 | $134.90 | $181.97 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $602.56 / $812.83
| Professional | TC | $398.11 | $602.56 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | 26 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $691.83 / $3,019.95
| Professional | | $426.58 | $691.83 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $851.14
| Professional | 26 | $104.71 | $165.96 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $537.03 / $2,570.40
| Professional | TC | $323.59 | $537.03 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $758.58 / $1,148.15
| Professional | | $645.65 | $758.58 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $186.21 / $288.40
| Professional | 26 | $162.18 | $186.21 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $562.34 / $870.96
| Professional | TC | $489.78 | $562.34 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Facility | 26 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $933.25 / $1,148.15
| Professional | | $758.58 | $933.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $177.83 / $288.40
| Professional | 26 | $147.91 | $177.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $562.34 / $758.58 / $870.96
| Professional | TC | $562.34 | $758.58 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $676.08 / $1,148.15
| Professional | | $426.58 | $676.08 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $165.96 / $218.78
| Professional | 26 | $97.72 | $165.96 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $524.81 / $707.95
| Professional | TC | $323.59 | $524.81 | $707.95 |