- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $104.71 / $288.40
| Facility | 26 | $64.57 | $104.71 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $257.04 / $724.44
| Professional | | $154.88 | $257.04 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $93.33 / $199.53
| Professional | 26 | $56.23 | $93.33 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $134.90 / $316.23
| Professional | TC | $97.72 | $134.90 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $123.03
| Professional | | $117.49 | $117.49 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $47.86 / $102.33
| Professional | 26 | $45.71 | $47.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $199.53 / $426.58
| Professional | | $162.18 | $199.53 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $79.43 / $125.89
| Professional | 26 | $63.10 | $79.43 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $125.89 / $281.84
| Professional | TC | $97.72 | $125.89 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $173.78 / $295.12
| Professional | | $162.18 | $173.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $66.07 / $91.20
| Professional | 26 | $64.57 | $66.07 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $107.15 / $218.78
| Professional | TC | $97.72 | $107.15 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $69.18 / $100.00
| Facility | 26 | $14.79 | $69.18 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $269.15 / $512.86
| Professional | | $144.54 | $269.15 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $151.36
| Professional | 26 | $52.48 | $79.43 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $190.55 / $389.05
| Professional | TC | $93.33 | $190.55 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $575.44 / $575.44
| Facility | 26 | $446.68 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $309.03 / $1,659.59
| Professional | | $190.55 | $309.03 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $89.13 / $524.81
| Professional | 26 | $58.88 | $89.13 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $234.42 / $1,318.26
| Professional | TC | $123.03 | $234.42 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $257.04 / $416.87
| Professional | | $169.82 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $75.86 / $144.54
| Professional | 26 | $58.88 | $75.86 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $169.82 / $288.40
| Professional | TC | $114.82 | $169.82 | $288.40 |