- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $363.08 / $398.11
| Facility | 26 | $288.40 | $363.08 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $426.58 / $933.25
| Professional | | $275.42 | $426.58 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $128.82 / $269.15
| Professional | 26 | $81.28 | $128.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $302.00 / $602.56
| Professional | TC | $190.55 | $302.00 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Professional | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Professional | 26 | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $389.05 / $616.60
| Professional | | $309.03 | $389.05 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $102.33 / $162.18
| Professional | 26 | $81.28 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $288.40 / $457.09
| Professional | TC | $229.09 | $288.40 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $93.33 / $131.83
| Facility | 26 | $19.95 | $93.33 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $446.68 / $891.25
| Professional | | $223.87 | $446.68 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $95.50 / $177.83
| Professional | 26 | $63.10 | $95.50 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $346.74 / $676.08
| Professional | TC | $162.18 | $346.74 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $588.84 / $758.58 / $758.58
| Facility | 26 | $588.84 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $524.81 / $3,388.44
| Professional | | $269.15 | $524.81 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $91.20 / $660.69
| Professional | 26 | $70.79 | $91.20 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $457.09 / $2,951.21
| Professional | TC | $190.55 | $457.09 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $416.87 / $676.08
| Professional | | $269.15 | $416.87 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $87.10 / $199.53
| Professional | 26 | $70.79 | $87.10 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $316.23 / $549.54
| Professional | TC | $190.55 | $316.23 | $549.54 |