- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $61.66 / $114.82
| Facility | 26 | $47.86 | $61.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $380.19 / $1,584.89
| Professional | | $295.12 | $380.19 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $67.61 / $125.89
| Professional | 26 | $41.69 | $67.61 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $316.23 / $724.44
| Professional | TC | $251.19 | $316.23 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Professional | 26 | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $389.05 / $630.96
| Professional | | $309.03 | $389.05 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $107.15
| Professional | 26 | $51.29 | $64.57 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $331.13 / $537.03
| Professional | TC | $257.04 | $331.13 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $389.05 / $549.54
| Professional | | $363.08 | $389.05 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $58.88 / $83.18
| Professional | 26 | $54.95 | $58.88 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $309.03 / $467.74
| Professional | TC | $295.12 | $309.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $446.68 / $676.08
| Professional | | $288.40 | $446.68 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $70.79 / $109.65
| Professional | 26 | $44.67 | $70.79 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $371.54 / $575.44
| Professional | TC | $245.47 | $371.54 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $234.42 / $234.42
| Facility | 26 | $117.49 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $467.74 / $2,344.23
| Professional | | $323.59 | $467.74 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $66.07 / $380.19
| Professional | 26 | $45.71 | $66.07 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $398.11 / $2,041.74
| Professional | TC | $275.42 | $398.11 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $436.52 / $741.31
| Professional | | $316.23 | $436.52 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $63.10 / $102.33
| Professional | 26 | $46.77 | $63.10 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $380.19 / $616.60
| Professional | TC | $263.03 | $380.19 | $616.60 |