- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Facility | 26 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $501.19 / $1,071.52
| Professional | | $354.81 | $501.19 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $134.90 / $269.15
| Professional | 26 | $85.11 | $134.90 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $794.33
| Professional | TC | $257.04 | $363.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $630.96 / $870.96
| Professional | | $562.34 | $630.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $158.49 / $213.80
| Professional | 26 | $134.90 | $158.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $467.74 / $645.65
| Professional | TC | $426.58 | $467.74 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $478.63 / $870.96
| Professional | | $295.12 | $478.63 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $186.21
| Professional | 26 | $70.79 | $97.72 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $316.23 / $707.95
| Professional | TC | $223.87 | $316.23 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $1,905.46
| Professional | | $1,737.80 | $1,737.80 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $524.81 / $630.96 / $630.96
| Professional | 26 | $524.81 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,412.54
| Professional | TC | $1,096.48 | $1,096.48 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Facility | 26 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $660.69 / $1,096.48
| Professional | | $489.78 | $660.69 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $162.18 / $245.47
| Professional | 26 | $120.23 | $162.18 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $501.19 / $870.96
| Professional | TC | $363.08 | $501.19 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $223.87
| Professional | | $32.36 | $33.11 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $707.95 / $851.14
| Professional | | $524.81 | $707.95 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $169.82 / $204.17
| Professional | 26 | $138.04 | $169.82 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $389.05 / $537.03 / $630.96
| Professional | TC | $389.05 | $537.03 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $1,071.52
| Professional | | $309.03 | $309.03 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $186.21
| Professional | 26 | $79.43 | $79.43 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $562.34
| Professional | TC | $234.42 | $234.42 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $467.74 / $891.25
| Professional | | $331.13 | $467.74 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $91.20 / $173.78
| Professional | 26 | $74.13 | $91.20 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $371.54 / $741.31
| Professional | TC | $257.04 | $371.54 | $741.31 |