- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $891.25 / $933.25
| Facility | 26 | $234.42 | $891.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $316.23 / $954.99
| Professional | | $165.96 | $316.23 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $112.20 / $316.23
| Professional | 26 | $61.66 | $112.20 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $257.04 / $851.14
| Professional | TC | $154.88 | $257.04 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $691.83 / $891.25
| Professional | | $295.12 | $691.83 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $125.89 / $269.15
| Professional | 26 | $53.70 | $125.89 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $489.78 / $630.96
| Professional | TC | $213.80 | $489.78 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $489.78 / $933.25
| Facility | 26 | $234.42 | $489.78 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $575.44 / $1,318.26
| Professional | | $234.42 | $575.44 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $190.55 / $467.74
| Professional | 26 | $83.18 | $190.55 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $407.38 / $851.14
| Professional | TC | $218.78 | $407.38 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $1,445.44
| Professional | | $851.14 | $851.14 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $257.04 / $436.52
| Professional | 26 | $234.42 | $257.04 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $524.81 / $602.56 / $1,023.29
| Professional | TC | $524.81 | $602.56 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $524.81 / $891.25
| Professional | | $363.08 | $524.81 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $208.93 / $269.15
| Professional | 26 | $64.57 | $208.93 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $489.78 / $630.96
| Professional | TC | $154.88 | $489.78 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $676.08 / $1,819.70
| Professional | | $239.88 | $676.08 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $190.55 / $407.38
| Professional | 26 | $70.79 | $190.55 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $457.09 / $1,412.54
| Professional | TC | $190.55 | $457.09 | $1,412.54 |