- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $58.88 / $79.43
| Facility | 26 | $52.48 | $58.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $416.87 / $794.33
| Professional | | $309.03 | $416.87 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $66.07 / $147.91
| Professional | 26 | $51.29 | $66.07 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $323.59 / $489.78
| Professional | TC | $251.19 | $323.59 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $380.19 / $645.65
| Professional | | $338.84 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $67.61 / $109.65
| Professional | 26 | $50.12 | $67.61 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $407.38 / $724.44
| Professional | | $263.03 | $407.38 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $81.28 / $123.03
| Professional | 26 | $58.88 | $81.28 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $416.87 / $645.65
| Professional | TC | $263.03 | $416.87 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $407.38 / $707.95
| Professional | | $229.09 | $407.38 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $72.44 / $120.23
| Professional | 26 | $56.23 | $72.44 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $338.84 / $602.56
| Professional | TC | $165.96 | $338.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Facility | 26 | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $3,235.94 / $3,235.94
| Professional | | $2,454.71 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $446.68 / $446.68
| Professional | 26 | $354.81 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,089.30 / $2,818.38 / $2,818.38
| Professional | TC | $2,089.30 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $380.19 / $645.65
| Professional | | $204.17 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $112.20
| Professional | 26 | $51.29 | $67.61 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $323.59 / $549.54
| Professional | TC | $154.88 | $323.59 | $549.54 |