- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $218.78 / $223.87
| Facility | 26 | $213.80 | $218.78 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $281.84 / $562.34
| Professional | | $158.49 | $281.84 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $123.03 / $257.04
| Professional | 26 | $97.72 | $123.03 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $173.78
| Professional | TC | $64.57 | $85.11 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $363.08 / $436.52
| Professional | | $354.81 | $363.08 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $186.21 / $257.04
| Professional | 26 | $117.49 | $186.21 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $269.15 / $363.08
| Professional | | $158.49 | $269.15 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $158.49 / $218.78
| Professional | 26 | $95.50 | $158.49 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $144.54
| Professional | TC | $64.57 | $107.15 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $380.19 / $489.78
| Professional | | $245.47 | $380.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $223.87 / $281.84
| Professional | 26 | $134.90 | $223.87 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $213.80
| Professional | TC | $109.65 | $162.18 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Facility | 26 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $371.54 / $1,148.15
| Professional | | $281.84 | $371.54 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $204.17 / $660.69
| Professional | 26 | $165.96 | $204.17 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $151.36 / $478.63
| Professional | TC | $123.03 | $151.36 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $380.19 / $489.78
| Professional | | $346.74 | $380.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $208.93 / $223.87 / $281.84
| Professional | 26 | $208.93 | $223.87 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $162.18 / $213.80
| Professional | TC | $138.04 | $162.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $389.05 / $426.58
| Professional | | $245.47 | $389.05 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $234.42 / $257.04
| Professional | 26 | $134.90 | $234.42 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $165.96
| Professional | TC | $109.65 | $154.88 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $346.74 / $457.09
| Professional | | $245.47 | $346.74 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $263.03
| Professional | 26 | $134.90 | $204.17 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $141.25 / $186.21
| Professional | TC | $93.33 | $141.25 | $186.21 |