- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $102.33
| Facility | 26 | $66.07 | $66.07 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $245.47 / $616.60
| Professional | | $199.53 | $245.47 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $131.83 / $323.59
| Professional | 26 | $58.88 | $131.83 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $213.80 / $1,479.11
| Professional | TC | $141.25 | $213.80 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $467.74 / $588.84
| Professional | | $389.05 | $467.74 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $128.82 / $158.49
| Professional | 26 | $107.15 | $128.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $338.84 / $426.58
| Professional | TC | $281.84 | $338.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $426.58 / $1,445.44
| Professional | | $208.93 | $426.58 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $114.82 / $512.86
| Professional | 26 | $64.57 | $114.82 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $309.03 / $1,047.13
| Professional | TC | $165.96 | $309.03 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $467.74
| Professional | | $446.68 | $446.68 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $141.25
| Professional | 26 | $125.89 | $125.89 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $331.13
| Professional | TC | $323.59 | $323.59 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $363.08 / $457.09
| Professional | | $269.15 | $363.08 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $102.33 / $128.82
| Professional | 26 | $75.86 | $102.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $263.03 / $331.13
| Professional | TC | $186.21 | $263.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $398.11 / $524.81
| Professional | | $234.42 | $398.11 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $114.82 / $138.04
| Professional | 26 | $67.61 | $114.82 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $281.84 / $380.19
| Professional | TC | $169.82 | $281.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $501.19 / $524.81
| Professional | | $426.58 | $501.19 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $141.25 / $147.91
| Professional | 26 | $120.23 | $141.25 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $363.08 / $380.19
| Professional | TC | $309.03 | $363.08 | $380.19 |