- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Facility | 26 | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $380.19 / $1,412.54
| Professional | | $288.40 | $380.19 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $100.00 / $208.93
| Professional | 26 | $79.43 | $100.00 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $269.15 / $537.03
| Professional | TC | $199.53 | $269.15 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $389.05 / $549.54
| Professional | | $275.42 | $389.05 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $104.71 / $162.18
| Professional | 26 | $79.43 | $104.71 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $389.05
| Professional | TC | $190.55 | $288.40 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $371.54 / $537.03
| Professional | | $165.96 | $371.54 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $151.36
| Professional | 26 | $75.86 | $104.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $269.15 / $389.05
| Professional | TC | $125.89 | $269.15 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $269.15 / $467.74
| Professional | | $4.57 | $269.15 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.12 / $83.18 / $141.25
| Professional | 26 | $1.12 | $83.18 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.47 / $186.21 / $323.59
| Professional | TC | $3.47 | $186.21 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $3.89 / $407.38
| Professional | | $3.89 | $3.89 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.95 / $0.95 / $125.89
| Professional | 26 | $0.95 | $0.95 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.95 / $213.80 / $281.84
| Professional | TC | $2.95 | $213.80 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $295.12
| Professional | | $269.15 | $269.15 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $83.18 / $89.13
| Professional | 26 | $79.43 | $83.18 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $208.93
| Professional | TC | $186.21 | $186.21 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $371.54 / $831.76
| Professional | | $42.66 | $371.54 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $107.15 / $158.49
| Professional | 26 | $79.43 | $107.15 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $407.38
| Professional | TC | $204.17 | $302.00 | $407.38 |