- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $77.62
| Facility | 26 | $64.57 | $64.57 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $380.19 / $1,949.84
| Professional | | $281.84 | $380.19 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $346.74
| Professional | 26 | $56.23 | $81.28 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $616.60
| Professional | TC | $234.42 | $309.03 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $323.59 / $501.19
| Professional | | $309.03 | $323.59 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $97.72
| Professional | 26 | $60.26 | $60.26 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $263.03 / $398.11
| Professional | TC | $245.47 | $263.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $512.86 / $602.56
| Professional | | $302.00 | $512.86 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $95.50 / $123.03
| Professional | 26 | $53.70 | $95.50 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $478.63
| Professional | TC | $251.19 | $416.87 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $416.87 / $524.81
| Professional | | $2.40 | $416.87 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.55 / $83.18 / $104.71
| Professional | 26 | $0.55 | $83.18 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1.86 / $338.84 / $676.08
| Professional | TC | $1.86 | $338.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $467.74
| Professional | | $2.40 | $2.40 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.55 / $0.55 / $93.33
| Professional | 26 | $0.55 | $0.55 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1.86 / $371.54 / $1,122.02
| Professional | TC | $1.86 | $371.54 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $309.03 / $309.03
| Professional | | $295.12 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $63.10 / $63.10
| Professional | 26 | $61.66 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $245.47 / $245.47
| Professional | TC | $234.42 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $323.59 / $630.96
| Professional | | $30.90 | $323.59 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $134.90
| Professional | 26 | $57.54 | $85.11 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $363.08 / $549.54
| Professional | TC | $234.42 | $363.08 | $549.54 |