- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $117.49 / $363.08
| Facility | 26 | $95.50 | $117.49 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $407.38 / $707.95
| Professional | | $223.87 | $407.38 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $102.33 / $165.96
| Professional | 26 | $56.23 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $281.84 / $524.81
| Professional | TC | $162.18 | $281.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $302.00 / $501.19
| Professional | | $213.80 | $302.00 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $117.49
| Professional | 26 | $53.70 | $72.44 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $223.87 / $380.19
| Professional | TC | $158.49 | $223.87 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $288.40 / $1,445.44
| Professional | | $77.62 | $288.40 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $77.62 / $109.65
| Professional | 26 | $66.07 | $77.62 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $309.03 / $380.19
| Professional | TC | $245.47 | $309.03 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $93.33
| Facility | 26 | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $467.74 / $776.25
| Professional | | $194.98 | $467.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $69.18 / $144.54
| Professional | 26 | $43.65 | $69.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $371.54 / $676.08
| Professional | TC | $151.36 | $371.54 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $251.19 / $338.84
| Professional | | $208.93 | $251.19 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $63.10 / $79.43
| Professional | 26 | $51.29 | $63.10 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $190.55 / $257.04
| Professional | TC | $154.88 | $190.55 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $758.58 / $776.25
| Professional | | $524.81 | $758.58 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $104.71 / $123.03
| Professional | 26 | $83.18 | $104.71 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $446.68
| Professional | | $371.54 | $371.54 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $354.81 / $1,659.59
| Professional | | $74.13 | $354.81 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $77.62 / $125.89
| Professional | 26 | $58.88 | $77.62 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $338.84 / $537.03
| Professional | TC | $186.21 | $338.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $371.54 / $812.83
| Professional | | $199.53 | $371.54 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $67.61 / $123.03
| Professional | 26 | $39.81 | $67.61 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $295.12 / $724.44
| Professional | TC | $147.91 | $295.12 | $724.44 |