- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $169.82 / $181.97
| Facility | 26 | $114.82 | $169.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $524.81 / $2,511.89
| Professional | | $346.74 | $524.81 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $158.49 / $346.74
| Professional | 26 | $97.72 | $158.49 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $338.84 / $645.65
| Professional | TC | $229.09 | $338.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Professional | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Professional | 26 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $436.52 / $562.34
| Professional | | $380.19 | $436.52 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $128.82 / $165.96
| Professional | 26 | $112.20 | $128.82 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $309.03 / $398.11
| Professional | TC | $269.15 | $309.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $281.84 / $501.19
| Professional | | $114.82 | $281.84 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $120.23 / $169.82
| Facility | 26 | $25.70 | $120.23 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $676.08 / $1,513.56
| Professional | | $346.74 | $676.08 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $138.04 / $229.09
| Professional | 26 | $93.33 | $138.04 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $446.68 / $1,380.38
| Professional | TC | $245.47 | $446.68 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $616.60 / $660.69
| Professional | | $602.56 | $616.60 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $204.17 / $223.87
| Professional | 26 | $186.21 | $204.17 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $446.68 / $724.44
| Professional | TC | $398.11 | $446.68 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $616.60 / $1,380.38
| Professional | | $346.74 | $616.60 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $125.89 / $223.87
| Professional | 26 | $95.50 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $426.58 / $1,023.29
| Professional | TC | $251.19 | $426.58 | $1,023.29 |