- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $114.82 / $134.90
| Facility | 26 | $85.11 | $114.82 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $257.04 / $501.19
| Professional | | $138.04 | $257.04 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $81.28 / $169.82
| Professional | 26 | $46.77 | $81.28 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $186.21 / $316.23
| Professional | TC | $95.50 | $186.21 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $60.26 / $87.10
| Facility | 26 | $13.18 | $60.26 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $269.15 / $512.86
| Professional | | $158.49 | $269.15 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $154.88
| Professional | 26 | $52.48 | $75.86 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $190.55 / $363.08
| Professional | TC | $104.71 | $190.55 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $331.13 / $407.38
| Professional | | $295.12 | $331.13 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $114.82 / $138.04
| Professional | 26 | $100.00 | $114.82 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $218.78 / $269.15
| Professional | TC | $190.55 | $218.78 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $114.82 / $134.90
| Facility | 26 | $85.11 | $114.82 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $338.84 / $501.19
| Professional | | $245.47 | $338.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $107.15 / $158.49
| Professional | 26 | $66.07 | $107.15 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $218.78 / $363.08
| Professional | TC | $158.49 | $218.78 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $117.49 / $218.78
| Professional | | $70.79 | $117.49 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $338.84 / $467.74
| Professional | | $165.96 | $338.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $109.65 / $154.88
| Professional | 26 | $52.48 | $109.65 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $229.09 / $371.54
| Professional | TC | $104.71 | $229.09 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | 26 | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $363.08 / $446.68
| Professional | | $275.42 | $363.08 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $114.82 / $154.88
| Professional | 26 | $97.72 | $114.82 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $234.42 / $295.12
| Professional | TC | $177.83 | $234.42 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $245.47 / $489.78
| Professional | | $141.25 | $245.47 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $162.18
| Professional | 26 | $48.98 | $70.79 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $181.97 / $323.59
| Professional | TC | $91.20 | $181.97 | $323.59 |