- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $263.03 / $537.03
| Facility | 26 | $128.82 | $263.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $269.15 / $549.54
| Professional | | $194.98 | $269.15 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $288.40
| Professional | 26 | $85.11 | $125.89 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $128.82 / $275.42
| Professional | TC | $97.72 | $128.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $275.42 / $512.86
| Professional | | $213.80 | $275.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $138.04 / $213.80
| Professional | 26 | $117.49 | $138.04 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $125.89 / $354.81
| Professional | TC | $97.72 | $125.89 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $446.68 / $645.65
| Professional | | $416.87 | $446.68 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $123.03 / $169.82
| Professional | 26 | $120.23 | $123.03 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $323.59 / $446.68
| Professional | TC | $295.12 | $323.59 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $128.82 / $186.21
| Facility | 26 | $27.54 | $128.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $562.34 / $977.24
| Professional | | $354.81 | $562.34 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $147.91 / $281.84
| Professional | 26 | $93.33 | $147.91 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $741.31
| Professional | TC | $251.19 | $416.87 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $831.76 / $1,071.52 / $1,071.52
| Facility | 26 | $831.76 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $575.44 / $1,905.46
| Professional | | $389.05 | $575.44 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $147.91 / $724.44
| Professional | 26 | $104.71 | $147.91 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $436.52 / $1,445.44
| Professional | TC | $309.03 | $436.52 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $512.86 / $851.14
| Professional | | $389.05 | $512.86 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $134.90 / $281.84
| Professional | 26 | $104.71 | $134.90 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $380.19 / $616.60
| Professional | TC | $269.15 | $380.19 | $616.60 |