- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $436.52 / $537.03
| Facility | 26 | $223.87 | $436.52 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $371.54 / $891.25
| Professional | | $194.98 | $371.54 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $141.25 / $288.40
| Professional | 26 | $70.79 | $141.25 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $218.78 / $616.60
| Professional | TC | $134.90 | $218.78 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $660.69 / $891.25
| Professional | | $275.42 | $660.69 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $138.04 / $269.15
| Professional | 26 | $58.88 | $138.04 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $537.03 / $630.96
| Professional | TC | $186.21 | $537.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $416.87 / $537.03
| Facility | 26 | $223.87 | $416.87 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $562.34 / $1,258.93
| Professional | | $288.40 | $562.34 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $204.17 / $512.86
| Professional | 26 | $107.15 | $204.17 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $363.08 / $741.31
| Professional | TC | $204.17 | $363.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $812.83 / $1,380.38
| Professional | | $794.33 | $812.83 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $257.04 / $281.84 / $478.63
| Professional | 26 | $257.04 | $281.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $478.63 / $537.03 / $891.25
| Professional | TC | $478.63 | $537.03 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $891.25
| Professional | | $338.84 | $501.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $239.88 / $269.15
| Professional | 26 | $70.79 | $239.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $562.34 / $776.25
| Professional | TC | $138.04 | $562.34 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $630.96 / $2,511.89
| Professional | | $229.09 | $630.96 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $208.93 / $537.03
| Professional | 26 | $77.62 | $208.93 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $338.84 / $1,584.89
| Professional | TC | $144.54 | $338.84 | $1,584.89 |