- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $309.03
| Facility | 26 | $75.86 | $107.15 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $446.68 / $1,548.82
| Professional | | $190.55 | $446.68 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $154.88 / $346.74
| Professional | 26 | $77.62 | $154.88 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $354.81 / $851.14
| Professional | TC | $245.47 | $354.81 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $316.23 / $489.78
| Facility | 26 | $181.97 | $316.23 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $616.60 / $3,467.37
| Professional | | $371.54 | $616.60 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $616.60
| Professional | 26 | $67.61 | $107.15 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $524.81 / $3,019.95
| Professional | TC | $295.12 | $524.81 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $151.36 / $199.53
| Professional | 26 | $87.10 | $151.36 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $645.65 / $1,071.52
| Professional | | $309.03 | $645.65 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $112.20 / $229.09
| Professional | 26 | $64.57 | $112.20 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $549.54 / $851.14
| Professional | TC | $239.88 | $549.54 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $338.84 / $630.96
| Professional | | $95.50 | $338.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $537.03 / $977.24
| Professional | | $346.74 | $537.03 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $117.49 / $204.17
| Professional | 26 | $77.62 | $117.49 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $389.05 / $660.69
| Professional | TC | $263.03 | $389.05 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $147.91 / $630.96
| Professional | | $109.65 | $147.91 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $316.23 / $489.78
| Facility | 26 | $181.97 | $316.23 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $616.60 / $3,467.37
| Professional | | $371.54 | $616.60 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $616.60
| Professional | 26 | $67.61 | $107.15 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $524.81 / $3,019.95
| Professional | TC | $295.12 | $524.81 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $562.34 / $1,202.26
| Professional | | $363.08 | $562.34 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $112.20 / $245.47
| Professional | 26 | $74.13 | $112.20 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $446.68 / $851.14
| Professional | TC | $281.84 | $446.68 | $851.14 |