- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $316.23 / $616.60 / $1,174.90
| Facility | 26 | $316.23 | $616.60 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $1,288.25
| Professional | | $269.15 | $389.05 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $93.33 / $295.12
| Professional | 26 | $70.79 | $93.33 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $269.15 / $933.25
| Professional | TC | $177.83 | $269.15 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $776.25 / $1,071.52
| Professional | | $398.11 | $776.25 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $169.82 / $302.00
| Professional | 26 | $72.44 | $169.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $549.54 / $776.25
| Professional | TC | $295.12 | $549.54 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $616.60 / $1,174.90
| Facility | 26 | $275.42 | $616.60 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $776.25 / $1,584.89
| Professional | | $346.74 | $776.25 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $245.47 / $501.19
| Professional | 26 | $85.11 | $245.47 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $575.44 / $1,318.26
| Professional | TC | $263.03 | $575.44 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,258.93 / $1,995.26
| Professional | | $1,174.90 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $316.23 / $346.74 / $575.44
| Professional | 26 | $316.23 | $346.74 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $794.33 / $912.01 / $1,412.54
| Professional | TC | $794.33 | $912.01 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $776.25 / $954.99
| Professional | | $426.58 | $776.25 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $169.82 / $295.12
| Professional | 26 | $72.44 | $169.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $549.54 / $660.69
| Professional | TC | $213.80 | $549.54 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $794.33 / $2,187.76
| Professional | | $331.13 | $794.33 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $257.04 / $741.31
| Professional | 26 | $95.50 | $257.04 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $537.03 / $1,445.44
| Professional | TC | $263.03 | $537.03 | $1,445.44 |