- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $120.23 / $467.74
| Facility | 26 | $64.57 | $120.23 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $398.11 / $707.95
| Professional | | $275.42 | $398.11 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $77.62 / $245.47
| Professional | 26 | $60.26 | $77.62 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $331.13 / $630.96
| Professional | TC | $218.78 | $331.13 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $524.81 / $794.33
| Professional | | $371.54 | $524.81 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $95.50 / $144.54
| Professional | 26 | $69.18 | $95.50 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $645.65
| Professional | TC | $302.00 | $426.58 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $446.68 / $977.24
| Professional | | $117.49 | $446.68 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $75.86 / $95.50
| Professional | 26 | $69.18 | $75.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $363.08 / $562.34
| Professional | TC | $316.23 | $363.08 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $489.78 / $851.14
| Professional | | $316.23 | $489.78 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $102.33 / $162.18
| Professional | 26 | $58.88 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $398.11 / $707.95
| Professional | TC | $257.04 | $398.11 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $524.81 / $562.34
| Professional | | $380.19 | $524.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $91.20 / $95.50
| Professional | 26 | $69.18 | $91.20 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $436.52 / $457.09
| Professional | TC | $316.23 | $436.52 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Professional | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $446.68 / $1,949.84
| Professional | | $77.62 | $446.68 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $100.00 / $169.82
| Professional | 26 | $77.62 | $100.00 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $524.81 / $870.96
| Professional | TC | $346.74 | $524.81 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $588.84 / $954.99
| Professional | | $363.08 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $104.71 / $165.96
| Professional | 26 | $63.10 | $104.71 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $478.63 / $794.33
| Professional | TC | $295.12 | $478.63 | $794.33 |