- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $81.28 / $117.49
| Facility | 26 | $66.07 | $81.28 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $309.03 / $870.96
| Professional | | $229.09 | $309.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $97.72 / $239.88
| Professional | 26 | $56.23 | $97.72 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $218.78 / $436.52
| Professional | TC | $162.18 | $218.78 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $288.40 / $524.81
| Professional | | $229.09 | $288.40 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $120.23
| Professional | 26 | $60.26 | $79.43 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $213.80 / $407.38
| Professional | TC | $169.82 | $213.80 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $123.03
| Facility | 26 | $120.23 | $120.23 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $346.74 / $588.84
| Professional | | $208.93 | $346.74 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $141.25
| Professional | 26 | $52.48 | $75.86 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $269.15 / $446.68
| Professional | TC | $151.36 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $380.19 / $1,258.93
| Professional | | $346.74 | $380.19 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $93.33 / $239.88
| Professional | 26 | $85.11 | $93.33 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $281.84 / $1,023.29
| Professional | TC | $257.04 | $281.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $239.88 / $338.84
| Professional | | $213.80 | $239.88 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $123.03
| Professional | 26 | $58.88 | $58.88 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $181.97 / $218.78
| Professional | TC | $165.96 | $181.97 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $363.08 / $588.84
| Professional | | $239.88 | $363.08 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $102.33 / $169.82
| Professional | 26 | $54.95 | $102.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $263.03 / $436.52
| Professional | TC | $186.21 | $263.03 | $436.52 |