- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $123.03
| Facility | 26 | $70.79 | $70.79 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $389.05 / $1,202.26
| Professional | | $194.98 | $389.05 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $128.82 / $269.15
| Professional | 26 | $66.07 | $128.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $234.42 / $524.81
| Professional | TC | $123.03 | $234.42 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $58.88 / $58.88
| Facility | 26 | $48.98 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $489.78 / $691.83
| Professional | | $316.23 | $489.78 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $173.78 / $251.19
| Professional | 26 | $114.82 | $173.78 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $338.84 / $446.68
| Professional | TC | $208.93 | $338.84 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $251.19 / $616.60
| Facility | 26 | $114.82 | $251.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $380.19 / $870.96
| Professional | | $295.12 | $380.19 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $131.83 / $218.78
| Professional | 26 | $83.18 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $676.08
| Professional | TC | $194.98 | $245.47 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $245.47 / $489.78
| Facility | 26 | $199.53 | $245.47 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $812.83
| Professional | | $295.12 | $295.12 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $186.21
| Professional | 26 | $104.71 | $104.71 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $524.81
| Professional | TC | $194.98 | $194.98 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Facility | 26 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $524.81 / $3,162.28
| Professional | | $239.88 | $524.81 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $158.49 / $602.56
| Professional | 26 | $83.18 | $158.49 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $316.23 / $2,754.23
| Professional | TC | $144.54 | $316.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $537.03 / $1,659.59
| Professional | | $85.11 | $537.03 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $186.21 / $575.44
| Professional | 26 | $83.18 | $186.21 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $354.81 / $1,071.52
| Professional | TC | $85.11 | $354.81 | $1,071.52 |