- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $141.25 / $338.84
| Facility | 26 | $83.18 | $141.25 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $524.81 / $1,778.28
| Professional | | $346.74 | $524.81 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $147.91 / $323.59
| Professional | 26 | $85.11 | $147.91 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $851.14
| Professional | TC | $257.04 | $363.08 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $346.74 / $537.03
| Facility | 26 | $199.53 | $346.74 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $3,162.28
| Professional | | $398.11 | $588.84 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $117.49 / $851.14
| Professional | 26 | $75.86 | $117.49 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $489.78 / $2,691.53
| Professional | TC | $316.23 | $489.78 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,230.27 / $1,819.70
| Professional | | $707.95 | $1,230.27 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $165.96 / $218.78
| Professional | 26 | $95.50 | $165.96 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $645.65 / $1,148.15
| Professional | | $295.12 | $645.65 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $125.89 / $251.19
| Professional | 26 | $67.61 | $125.89 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $524.81 / $891.25
| Professional | TC | $257.04 | $524.81 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $363.08 / $676.08
| Professional | | $104.71 | $363.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $562.34 / $954.99
| Professional | | $371.54 | $562.34 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $223.87
| Professional | 26 | $85.11 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $416.87 / $707.95
| Professional | TC | $275.42 | $416.87 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $173.78 / $691.83
| Professional | | $123.03 | $173.78 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $346.74 / $537.03
| Facility | 26 | $199.53 | $346.74 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $3,162.28
| Professional | | $398.11 | $588.84 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $117.49 / $851.14
| Professional | 26 | $75.86 | $117.49 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $489.78 / $2,691.53
| Professional | TC | $316.23 | $489.78 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $562.34 / $1,148.15
| Professional | | $380.19 | $562.34 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $120.23 / $281.84
| Professional | 26 | $81.28 | $120.23 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $446.68 / $831.76
| Professional | TC | $302.00 | $446.68 | $831.76 |