- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $245.47 / $309.03
| Facility | 26 | $177.83 | $245.47 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $234.42 / $549.54
| Professional | | $162.18 | $234.42 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $199.53
| Professional | 26 | $51.29 | $72.44 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $436.52
| Professional | TC | $112.20 | $173.78 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $524.81 / $776.25
| Professional | | $245.47 | $524.81 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $107.15 / $234.42
| Professional | 26 | $45.71 | $107.15 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $363.08 / $562.34
| Professional | TC | $169.82 | $363.08 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $199.53 / $309.03
| Facility | 26 | $177.83 | $199.53 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $478.63 / $1,071.52
| Professional | | $234.42 | $478.63 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $158.49 / $363.08
| Professional | 26 | $66.07 | $158.49 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $309.03 / $676.08
| Professional | TC | $173.78 | $309.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $794.33 / $1,230.27
| Professional | | $691.83 | $794.33 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $218.78 / $363.08
| Professional | 26 | $199.53 | $218.78 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $588.84 / $851.14
| Professional | TC | $467.74 | $588.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $436.52 / $691.83
| Professional | | $302.00 | $436.52 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $107.15 / $234.42
| Professional | 26 | $45.71 | $107.15 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $331.13 / $575.44
| Professional | TC | $154.88 | $331.13 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $467.74 / $1,202.26
| Professional | | $229.09 | $467.74 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $162.18 / $389.05
| Professional | 26 | $61.66 | $162.18 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $371.54 / $831.76
| Professional | TC | $154.88 | $371.54 | $831.76 |