- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $56.23
| Facility | 26 | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $346.74 / $436.52
| Professional | | $288.40 | $346.74 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $57.54 / $125.89
| Professional | 26 | $47.86 | $57.54 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $288.40 / $371.54
| Professional | TC | $239.88 | $288.40 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $758.58 / $954.99
| Professional | | $691.83 | $758.58 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $128.82 / $162.18
| Professional | 26 | $117.49 | $128.82 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $630.96 / $794.33
| Professional | TC | $575.44 | $630.96 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $489.78 / $812.83
| Professional | | $302.00 | $489.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $75.86 / $165.96
| Professional | 26 | $51.29 | $75.86 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $407.38 / $891.25
| Professional | TC | $257.04 | $407.38 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Professional | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Professional | 26 | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Professional | TC | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $602.56 / $630.96
| Professional | | $436.52 | $602.56 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $97.72 / $107.15
| Professional | 26 | $72.44 | $97.72 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $501.19 / $524.81
| Professional | TC | $363.08 | $501.19 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $588.84 / $891.25
| Professional | | $380.19 | $588.84 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $95.50 / $151.36
| Professional | 26 | $66.07 | $95.50 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $501.19 / $741.31
| Professional | TC | $316.23 | $501.19 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $630.96 / $630.96
| Professional | | $537.03 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $109.65 / $109.65
| Professional | 26 | $93.33 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $524.81 / $524.81
| Professional | TC | $446.68 | $524.81 | $524.81 |