- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $165.96 / $489.78
| Facility | 26 | $109.65 | $165.96 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $478.63 / $1,148.15
| Professional | | $309.03 | $478.63 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $123.03 / $302.00
| Professional | 26 | $91.20 | $123.03 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $331.13 / $602.56
| Professional | TC | $223.87 | $331.13 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $81.28 / $173.78
| Professional | 26 | $77.62 | $81.28 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Professional | TC | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $457.09 / $812.83
| Professional | | $354.81 | $457.09 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $131.83 / $204.17
| Professional | 26 | $107.15 | $131.83 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $331.13 / $645.65
| Professional | TC | $251.19 | $331.13 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $416.87 / $645.65
| Professional | | $389.05 | $416.87 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $112.20 / $154.88
| Professional | 26 | $109.65 | $112.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $302.00 / $512.86
| Professional | TC | $275.42 | $302.00 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $117.49 / $169.82
| Facility | 26 | $25.70 | $117.49 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $588.84 / $1,047.13
| Professional | | $346.74 | $588.84 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $134.90 / $269.15
| Professional | 26 | $89.13 | $134.90 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $426.58 / $776.25
| Professional | TC | $245.47 | $426.58 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $758.58 / $977.24 / $977.24
| Facility | 26 | $758.58 | $977.24 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $602.56 / $2,570.40
| Professional | | $363.08 | $602.56 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $138.04 / $660.69
| Professional | 26 | $100.00 | $138.04 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $446.68 / $2,041.74
| Professional | TC | $257.04 | $446.68 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $512.86 / $912.01
| Professional | | $346.74 | $512.86 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $125.89 / $275.42
| Professional | 26 | $95.50 | $125.89 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $602.56
| Professional | TC | $257.04 | $363.08 | $602.56 |