- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $93.33 / $128.82
| Facility | 26 | $83.18 | $93.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $302.00 / $660.69
| Professional | | $218.78 | $302.00 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $93.33 / $234.42
| Professional | 26 | $63.10 | $93.33 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $213.80 / $407.38
| Professional | TC | $144.54 | $213.80 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $288.40 / $549.54
| Professional | | $234.42 | $288.40 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $100.00 / $151.36
| Professional | 26 | $74.13 | $100.00 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $194.98 / $407.38
| Professional | TC | $154.88 | $194.98 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Facility | 26 | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $354.81 / $630.96
| Professional | | $213.80 | $354.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $93.33 / $169.82
| Professional | 26 | $64.57 | $93.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $257.04 / $489.78
| Professional | TC | $144.54 | $257.04 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $426.58 / $1,288.25
| Professional | | $323.59 | $426.58 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $117.49 / $269.15
| Professional | 26 | $107.15 | $117.49 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $239.88 / $1,023.29
| Professional | TC | $218.78 | $239.88 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $229.09 / $338.84
| Professional | | $204.17 | $229.09 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $75.86 / $154.88
| Professional | 26 | $74.13 | $75.86 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $154.88 / $186.21
| Professional | TC | $144.54 | $154.88 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $371.54 / $616.60
| Professional | | $239.88 | $371.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $128.82 / $213.80
| Professional | 26 | $63.10 | $128.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $263.03 / $436.52
| Professional | TC | $154.88 | $263.03 | $436.52 |