- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $208.93 / $288.40
| Facility | 26 | $95.50 | $208.93 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $281.84 / $724.44
| Professional | | $190.55 | $281.84 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $83.18 / $213.80
| Professional | 26 | $54.95 | $83.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $213.80 / $457.09
| Professional | TC | $134.90 | $213.80 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $151.36 / $165.96
| Professional | | $83.18 | $151.36 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $47.86 / $56.23
| Professional | 26 | $43.65 | $47.86 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $281.84 / $446.68
| Professional | | $223.87 | $281.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $74.13 / $117.49
| Professional | 26 | $58.88 | $74.13 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $208.93 / $331.13
| Professional | TC | $165.96 | $208.93 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $67.61 / $95.50
| Facility | 26 | $14.45 | $67.61 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $302.00 / $616.60
| Professional | | $165.96 | $302.00 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $75.86 / $138.04
| Professional | 26 | $45.71 | $75.86 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $218.78 / $467.74
| Professional | TC | $117.49 | $218.78 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $426.58 / $549.54 / $549.54
| Facility | 26 | $426.58 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $363.08 / $2,344.23
| Professional | | $199.53 | $363.08 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $72.44 / $537.03
| Professional | 26 | $56.23 | $72.44 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $302.00 / $1,995.26
| Professional | TC | $141.25 | $302.00 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $295.12 / $501.19
| Professional | | $177.83 | $295.12 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $70.79 / $151.36
| Professional | 26 | $56.23 | $70.79 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $218.78 / $371.54
| Professional | TC | $141.25 | $218.78 | $371.54 |