- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $190.55 / $512.86
| Facility | 26 | $144.54 | $190.55 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $512.86 / $2,187.76
| Professional | | $338.84 | $512.86 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $158.49 / $389.05
| Professional | 26 | $97.72 | $158.49 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $346.74 / $851.14
| Professional | TC | $234.42 | $346.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $263.03 / $281.84
| Professional | | $245.47 | $263.03 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $77.62 / $173.78
| Professional | 26 | $66.07 | $77.62 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $407.38
| Professional | TC | $165.96 | $165.96 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $512.86 / $1,445.44
| Professional | | $363.08 | $512.86 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $128.82 / $218.78
| Professional | 26 | $109.65 | $128.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $363.08 / $1,318.26
| Professional | TC | $251.19 | $363.08 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $363.08 / $645.65
| Professional | | $346.74 | $363.08 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $114.82 / $158.49
| Professional | 26 | $109.65 | $114.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $251.19 / $478.63
| Professional | TC | $234.42 | $251.19 | $478.63 |
- 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
- $309.03 / $602.56 / $1,348.96
| Professional | | $309.03 | $602.56 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $144.54 / $269.15
| Professional | 26 | $91.20 | $144.54 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $436.52 / $1,122.02
| Professional | TC | $229.09 | $436.52 | $1,122.02 |
- 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
- $380.19 / $831.76 / $6,025.60
| Professional | | $380.19 | $831.76 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $891.25
| Professional | 26 | $100.00 | $154.88 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $630.96 / $5,495.41
| Professional | TC | $269.15 | $630.96 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $549.54 / $1,230.27
| Professional | | $338.84 | $549.54 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $128.82 / $295.12
| Professional | 26 | $95.50 | $128.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $380.19 / $954.99
| Professional | TC | $257.04 | $380.19 | $954.99 |