- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $67.61 / $1,071.52
| Facility | 26 | $60.26 | $67.61 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $398.11 / $794.33
| Professional | | $295.12 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $66.07 / $144.54
| Professional | 26 | $51.29 | $66.07 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $323.59 / $602.56
| Professional | TC | $251.19 | $323.59 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $398.11 / $512.86
| Professional | | $162.18 | $398.11 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $67.61
| Professional | 26 | $53.70 | $53.70 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $380.19 / $436.52
| Professional | TC | $338.84 | $380.19 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $457.09 / $954.99
| Professional | | $234.42 | $457.09 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $141.25
| Professional | 26 | $51.29 | $74.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $398.11 / $851.14
| Professional | TC | $169.82 | $398.11 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $645.65
| Professional | | $316.23 | $478.63 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $61.66 / $89.13
| Professional | 26 | $43.65 | $61.66 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $416.87 / $562.34
| Professional | TC | $275.42 | $416.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $371.54 / $776.25
| Professional | | $177.83 | $371.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $128.82
| Professional | 26 | $44.67 | $67.61 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $323.59 / $660.69
| Professional | TC | $138.04 | $323.59 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $446.68 / $645.65
| Professional | | $288.40 | $446.68 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $85.11
| Professional | 26 | $40.74 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $380.19 / $562.34
| Professional | TC | $251.19 | $380.19 | $562.34 |